36 research outputs found
A kórház-főparancsnokságtól a tranzithálózatig : Interjú dr. Halmosi Zsolt r. vezérőrnaggyal, rendészeti országos rendőrfőkapitány-helyettessel
No full textAccording to the government decree no. 72/2020. (III. 28.) Korm. On Hospital Commander and Protection of Health Stock the minister responsible for law enforcement – Sándor Pintér, deputy prime minister and minister for interior - made for control of health stock purchased by budget sources a proposal on appointment of hospital commanders to health institutes. According to that higher leader of the Police control and coordinate the economization of health institutes using health stock purchased by budget sources. The leader of the health institute is obliged to fulfil the regulations of the hospital commander on containment of pandemic and on safekeeping of health stock. On the other side a hospital commander must not give proposals and take decisions in medical professional topics. About practical fulfilment and handling of eventual problems and further about the application of the „Hungarian invention” of transit network we asked Dr. Zsolt Halmosi, pol. major general, deputy director of the Hungarian Police Director for law enforcement, and newly appointed national commander-in-chief for hospitals. He was asked by Zsuzsanna Hornyik. After termination of the special legal order we will ask Dr. Zsolt Halmosi to summarize experiences in handling the pandemic. A kórházparancsnokról és az egészségügyi készlet védelméről szóló 72/2020. (III. 28.) Korm. rendelet szerint a költségvetési forrásból beszerzett egészségügyi készletek felhasználásának ellenőrzésére a rendészetért felelős miniszter – Pintér Sándor miniszterelnök-helyettes, belügyminiszter – javaslatot tett az egészség-ügyi intézményekhez kórházparancsnokok kirendelésére. Ennek megfelelően 2020. március 29-étől a hivatásos állomány felsővezetői felügyelik és koordinálják a költségvetési forrásból beszerzett egészségügyi készleteket felhaszná-ló egészségügyi intézmények anyaggazdálkodását. A kórházparancsnoknak a járványveszéllyel összefüggő szabályok betartására és az egészségügyi készlet megóvására vonatkozó javaslatát az egészségügyi intézmény vezetője köteles végrehajtani. Ugyanakkor a kórházparancsnok orvosszakmai kérdésekben nem tehet javaslatot, és nem hozhat döntést. A gyakorlati megvalósulásról, az esetlegesen felmerülő problémák kezeléséről, valamint a „magyar találmányként” alkalmazott tranzithálózatról is kérdeztük dr. Halmosi Zsolt r. vezérőrnagyot, rendészeti országos rendőrfőkapitány-helyettest, újonnan kinevezett országos kórházfőparancsnokot, akinek a kérdéseket Hornyik Zsuzsanna tette fel. A veszélyhelyzet megszűnését követően megkérjük vezérőrnagy urat, hogy egy újabb interjúban összegezze a járványhelyzet kezelése során szerzett tapasztalatokat
A kormányzati támogatások hatása a járműipari vállalatok pénzügyi teljesítményére az Ipar 4.0 korában Magyarországon = The effect of fiscal support on the financial performance of companies in the automotive sector in the era of Industry 4.0
No full textA járműipar kormányzati támogatása egyike a gazdaságpolitika örökzöld témaköreinek. Az
elmúlt évtizedekben a költségvetés terhére nyújtott jelentős összegű támogatások jelentős
hatással voltak a külföldi működőtőke beáramlására, a kutatás-fejlesztésre, a
technológiatranszferre, valamint a beszállítói kapcsolatok fejlődésére. A 2011-ben
Németországból elfogadott Ipar 4.0 kezdeményezés a járműipari vállalatok működésére is
hatást gyakorol. Bár az Ipar 4.0 és a járműipar kapcsolatával számos kutatás foglalkozik, a
kormányzati támogatások pénzügyi teljesítményre gyakorolt hatásait kevesen vizsgálták
ezidáig. A szerző a cikkben azt vizsgálja, mennyiben figyelhető meg eltérés a hazai járműipari
vállalkozások pénzügyi teljesítményében az ún. egyedi kormányzati döntés (EKD) útján
nyújtott támogatások által. A hazai járműipar teljesítménye több szempont szerint is elmarad a
visegrádi országok járműipari teljesítményétől. Az iparágban végbemenő átalakulási
folyamatok szükségessé teszik a kormányzati források allokációjának felülvizsgálatát, különös
tekintettel a beszállítói hálózatok teljesítményének fokozásának szükségessége miatt az Ipar 4.0
korában.
=
Government support of the automotive industry is an evergreen field of economic policy. Fiscal
support in recent decades had a significant effect on foreign direct investment inflow, research
and development, technology transfer and the development of supply chains. Industry 4.0
initiative declared by Germany in 2011 had an influence on the operation of automotive
companies. Although the relationship between Industrie 4.0 and the automotive industry is
widely analysed, the effect of government grants on the financial performance of companies
has not been investigated yet. The author aims to analyse the differences in the financial
performance of automotive companies receiving unique government grant to companies not
having received a grant. The financial performance of Hungarian automotive companies lags
behind the performance of firms in the Visegrad-countries in many aspects. Transformations
taking place in the industry call for the supervision of the allocation of government grants, in
order to raise the performance of supply especially in the era of Industry 4.0
A citokeratin-18 sejthalálmarker vizsgálata sikeres cardiopulmonalis resuscitatión átesett betegpopulációban = The prognostic value of cytokeratin-18 cell death marker in cardiac arrest survivors
No full textAbsztrakt:
Bevezetés: Citokeratin-18 (CK-18) az újraélesztés kapcsán
kialakuló ischaemiás-reperfúziós károsodás kiváltotta teljes sejthalál során
kerül a véráramba. Kaszpázok által hasított formája specifikus az apoptózis
folyamatára. A markerek számos kórképben prognosztikus értékűnek bizonyultak.
Tanulmányunkban elsőként vizsgáltuk prognosztikus értéküket reanimált
betegpopulációban. Módszer: 40, sikeresen újraélesztett
betegnél határoztuk meg a sejthalálmarkerek szintjét 6 órán belül, 24 és 72 óra
múlva. Ezeket összevetettük a 30 napos túléléssel, a neurológiai kimenetellel, a
szervfunkciós károsodást jellemző laboratóriumi, fizikális és terápiás
jellemzőkkel, valamint a reanimáció körülményeivel. Eredmények:
A reanimált betegek CK-18-plazmakoncentrációja a szakirodalomban leírt
egészséges, posztoperatív és szeptikus populáció értékeinek a többszöröse volt
(3842 vs. 242; 559; 1644 ng/l); a hasított és intakt CK-18 aránya alacsonyabb
volt (0,14 vs. 0,58; 0,22; 0,24), ami jelentős sejtkárosodásra és a nekrózis
dominanciájára utal. A markerek szintje azonban nem mutatott összefüggést a
túléléssel, a neurológiai statusszal és a reanimáció körülményeivel sem.
Veseelégtelenség esetén a CK-18 szintjének csökkenése elmaradt. Szignifikáns
negatív korrelációt figyeltünk meg a 6 órás hemoglobin- és CK-18-szint között (r
= –0,400, p<0,01), a 30 napos túlélésnek mégis az alacsonyabb
hemoglobinértékek kedveztek. Következtetés: Várakozásunkkal
ellentétben a vizsgált markerek nem bírtak prognosztikus értékkel újraélesztett
betegpopulációban. A kimenetelt valószínűleg nem a teljes sejtkárosodás, hanem
egy kisebb, a fenti markerekkel szenzitíven nem vizsgálható kritikus szerepű
sejtpopuláció károsodása, valamint a beteg tartalékkapacitásai befolyásolják.
Orv Hetil. 2020; 161(1): 26–32.
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Abstract:
Introduction: Cytokeratin-18 (CK-18) is releasing into the blood
during systemic cell death due to ischemia-reperfusion injury after cardiac
arrest. Its caspase-cleaved form is specific to apoptosis. Previous
investigations proved their prognostic value in different conditions. We firstly
investigated the prognostic value of these markers after cardiac arrest.
Method: Plasma samples of 40 resuscitated patients were
collected 6, 24, and 72 hours after successful resuscitation to determine the
marker concentrations. We investigated the association of the markers with the
30-day mortality, neurological outcome, circumstances of the cardiac arrest,
laboratory and physical parameters. Results: Resuscitated
patients had highly elevated CK-18 levels (3842 vs. 242; 559; 1644 ng/L) and
decreased caspase-cleaved CK-18/CK-18 ratio (0.14 vs. 0.58; 0.22; 0.24) compared
to healthy subjects, septic and postoperative patients suggesting severe grade
of cell death, mainly necrosis. Neither the marker concentrations nor their
kinetics showed difference between survivors and non-survivors. They did not
show association with the length of the resuscitation, the initial rhythm or the
neurological outcome either. CK-18 decreased in patients with good renal
function in contrast to patients with renal failure. Significant negative
correlation was observed between the 6-hour cytokeratin-18 and hemoglobin
concentrations (r = –0.400, p<0.01), while the 30-day survival was associated
with lower hemoglobin levels. Conclusion: Surprisingly the
biomarkers did not show prognostic value among resuscitated population. The
outcome is probably not determined by the complete cell damage, but the loss of
a small group of cells with critical role and the reserve capacity of the
patient. Orv Hetil. 2020; 161(1): 26–32
P6050Progression of vascular changing and hypertensive retinopathy during bradykinin B1 receptor antagonist treatment in SHR rats
No full textCardioprotection by resveratrol: A human clinical trial in patients with stable coronary artery disease
No full textAbstract. Several beneficial effects of resveratrol (RES), a natural antioxidant present in red wine have already been described. The aim of our study was to investigate if RES had a clinically measurable cardioprotective effect in patients after myocardial infarction. In this double-blind, placebo controlled trial 40 post-infarction Caucasian patients were randomized into two groups. One group received 10 mg RES capsule daily for 3 months. Systolic and diastolic left ventricular function, flow-mediated vasodilation (FMD), several laboratory and hemorheological parameters were measured before and after the treatment. Left ventricular ejection fraction showed an increasing tendency (ns) by RES treatment. However, left ventricular diastolic function was improved significantly (p < 0.01) by RES. A significant improvement in endothelial function measured by FMD was also observed (p < 0.05). Low-density lipoprotein (LDL) level significantly decreased (p < 0.05) in the RES treated group. Red blood cell deformability decreased and platelet aggregation increased significantly in the placebo group (p < 0.05), while resveratrol treatment has prevented these unfavourable changes. Concerning other measured parameters no significant changes were observed neither in placebo nor in RES group. Our results show that resveratrol improved left ventricle diastolic function, endothelial function, lowered LDL-cholesterol level and protected against unfavourable hemorheological changes measured in patients with coronary artery disease (CAD)
Navigating between Scylla and Charybdis: challenges and strategies for implementing guideline-directed medical therapy in heart failure with reduced ejection fraction
No full textGuideline-directed medical therapy (GDMT) has the potential to reduce the risks of mortality and hospitalisation in patients with heart failure (HF) with reduced ejection fraction (HFrEF). However, real-world data indicate that many patients with HFrEF do not receive optimised GDMT, which involves several different medications, many of which require up-titration to target doses. There are many challenges to implementing GDMT, the most important being patient-related factors (comorbidities, advanced age, frailty, cognitive impairment, poor adherence, low socioeconomic status), treatment-related factors (intolerance, side-effects) and healthcare-related factors that influence availability and accessibility of HF care. Accordingly, international disparities in resources for HF management and limited public reimbursement of GDMT, coupled with clinical inertia for treatment intensification combine to hinder efforts to provide GDMT. In this review paper, authors aim to provide solutions based on available evidence, practical experience, and expert consensus on how to utilise evolving strategies, novel medications, and patient profiling to allow the more comprehensive uptake of GDMT. Authors discuss professional education, motivation, and training, as well as patient empowerment for self-care as important tools to overcome clinical inertia and boost GDMT implementation. We provide evidence on how multidisciplinary care and institutional accreditation can be successfully used to increase prescription rates and adherence to GDMT. We consider the role of modern technologies in advancing professional and patient education and facilitating patient–provider communication. Finally, authors emphasise the role of novel drugs (especially sodium–glucose co-transporter 2 inhibitors), and a tailored approach to drug management as evolving strategies for the more successful implementation of GDMT
Prognosis, disease progression, and treatment of atrial fibrillation patients during 1 year: Follow-up of the Euro Heart Survey on Atrial Fibrillation
No full textAims: To gain insight in the prognosis and treatment of atrial fibrillation (AF) patients during 1-year follow-up in the Euro Heart Survey (EHS) on AF. Methods and results: The EHS enrolled 5333 AF patients in 2003-2004. One-year follow-up data were available for 80%. Of first detected AF patients, 46% did not have a recurrence during 1 year, paroxysmal AF largely remained paroxysmal AF (80%), and 30% of persistent AF progressed to permanent AF. Many treatment changes occurred since baseline. Oral anticoagulation was started in 19% and discontinued in 16% of all patients. Of patients initially on rhythm control 27% did not receive rhythm control during follow-up, whereas 15% of patients initially on rate control received rhythm control. Mortality was highest in permanent AF (8.2%), but also substantial in first detected AF (5.7%). In multivariable analysis, sinus rhythm at baseline was associated with lower mortality, but no significant effect was observed regarding the application of either rhythm or rate control. Conclusion: The EHS on AF provides unique prospective observational data on AF progression, long-term treatment, prognosis, and determinants of adverse outcome of the total clinical spectrum of AF in a European cardiology-based patient cohort. © The Author 2008
Investment expenditure of voivodships after introducing an individual debt ratio. Assessment of the possibility of development in the new conditions
No full textOkreślenie dopuszczalnego poziomu zadłużenia jest ważną kwestią dla każdej jednostki samorządu terytorialnego w Polsce, a jej ranga jeszcze rośnie, jeśli samorząd odczuwa silną presję na dbanie o rozwój obszaru, na którym funkcjonuje, borykając się równocześnie z niedostatkiem dochodów. Taka sytuacja dotyczy większości województw samorządowych, które spośród wszystkich szczebli struktury samorządowej są najbardziej skupione na finansowaniu rozwoju (o czym świadczy relacja wydatków inwestycyjnych do wydatków ogółem), dysponując równocześnie bardzo ograniczoną samodzielnością finansową. Celem artykułu jest zbadanie zmian poziomu zadłużenia oraz wydatków inwestycyjnych województw samorządowych w trzyletnim okresie obowiązywania indywidualnego wskaźnika zadłużenia w porównaniu z okresem przed jego wprowadzeniem. Badania wskazują na wyraźny spadek zarówno nominalny, jak i udziału w strukturze wydatków inwestycyjnych w przypadku województw samorządowych. Nie może być on jednak wiązany jedynie z wprowadzeniem indywidualnego wskaźnika zadłużenia. Na tę sytuację złożyło się m.in. rozpoczęcie nowego okresu budżetowania w Unii Europejskiej.Determining the permissible level of indebtedness is an important issue for each local government unit in Poland. Its prominance grows even more if strong pressure to care for the development is being put on the local government, while it is struggling with a shortage of revenue. This situation applies to the majority of voivodships, which, among all the levels of the local government structure, are the most focused on financing development (as demonstrated by the share of investment expenditure in total expenditure) while having very limited financial independence. The aim of the article is to examine the level and changes in investment expenditures and the level of debt of voivodships during the three-year period of the individual debt ratio and compare them with trends that had been characteristic for these categories before the introduction of this index. This issue is particularly important and interesting due to the participation of voivodships in financing the development of infrastructure in the country. The conducted research indicates a clear nominal and share in the structure of investment expenditures in the case of self-governing voivodships. However, they can not be associated only with the introduction of the individual debt ratio. Other factors, such as the start of a new budgeting period in the European Union, have also contributed to this situation.Alicja Sekuła: [email protected] Śmiechowicz: [email protected] Sekuła - Wydział Zarządzania i Ekonomii, Politechnika GdańskaJoanna Śmiechowicz - Wydział Ekonomiczny, Uniwersytet M. Curie-SkłodowskiejAyogu M.D., 1999, Before Prebendalism: A Positive Analysis of Core Infrastructure Investment in a Developing Fiscal Federalism, “African Development Review”, vol. 11, iss. 2, DOI: 10.1111/1467-8268.00008.Dafflon B., 2002, Local Public Finance in Europe: Balancing the Budget and Controlling Debt, Studies in Fiscal Federalism and State-local Finance, Edvard Elgar, Northampton.Dylewski M., 2014, Zadłużenie JST – problemy nowej perspektywy finansowej UE, „Studia Ekonomiczne”, nr 198.Filipiak B. Z., 2017, Dług jako determinanta stabilności systemu finansów samorządowych, „Kwartalnik Kolegium Ekonomiczno-Społecznego Studia i Prace”, nr 1.Halmosi P., 2013, The effect of the economic crisis on local governments in OECD Countries, “Public Finance Quarterly”, vol. 58, iss. 3.Jastrzębska M., 2016, Zadłużanie się jednostek samorządu terytorialnego w parabankach – przyczyny, skutki, przeciwdziałanie, „Ekonomiczne Problemy Usług”, nr 125, s. 187-200, DOI: 10.18276/epu.2016.125-15.Jastrzębska M., 2017, Dług ukryty jednostek samorządu terytorialnego – przyczyny, skutki, przeciwdziałanie, “Annales Universitatis Mariae Curie-Skłodowska Lublin – Polonia. Sectio H”, nr LI, 4, DOI:10.17951/h.2017.51.4.125.Kata R., 2015, Ryzyko finansowe w kontekście zadłużenia jednostek samorządu terytorialnego w Polsce, „Optimum. Studia Ekonomiczne”, nr 4(76), DOI: 10.15290/ose.2015.04.76.04.Kotlińska J., 2014, Finanse JST w nowych regułach zadłużeniowych, „Roczniki Ekonomiczne Kujawsko-Pomorskiej Szkoły Wyższej w Bydgoszczy”, nr 7.Kozera A., 2017, Rosnące zadłużenie jednostek samorządu terytorialnego jako zagrożenie dla rozwoju lokalnego, „Nierówności Społeczne a wzrost gospodarczy”, nr 49.KR RIO, Sprawozdania z działalności Regionalnych Izb Obrachunkowych i wykonania budżetu przez jednostki samorządu terytorialnego za lata 2009-2016, https://www.rio.gov.pl/modules.php?op=modload&name=HTML&file=index&page=publ_sprawozdaniaLewis B.D., Oosterman A., 2011, Sub-national government capital spending in Indonesia: level, structure, and financing, “Public Administration and Development”, no. 31, DOI: 10.1002/pad.582.Miszczuk M., Kawałko B., 2017, Zadłużenie jednostek samorządu terytorialnego jako uwarunkowanie absorbcji środków unijnych, „Roczniki Nauk Społecznych”, t. 9(45), nr 3, DOI: 10.18290/rns.2017.45.3-4.Ofiarski Z., 2010, Dług publiczny jednostek samorządu terytorialnego, „Finanse Komunalne”, nr 1-2.Poniatowicz M., 2012, Determinanty, dynamika i zróżnicowania terytorialne deficytu i zadłużenia sektora samorządu terytorialnego w Polsce, „Ekonomiczne Problemy Usług”, nr 100.Poniatowicz M., Salachna J., Perło D., 2010, Efektywne zarządzanie długiem w jednostce samorządu terytorialnego, Wolters Kluwer, Warszawa.Rogowska M., 2010, Zmiana wybranych elementów infrastruktury technicznej gmin powiatu kłodzkiego w latach 2003-2006, [w:] Dylematy rozwoju lokalnego i regionalnego na początku XXI wieku, Korenik S., Dybała A. (red.), „Prace Naukowe Uniwersytetu Ekonomicznego”, nr 101.Sawicka K., 2012, Założenia reformy finansów samorządowych i ich realizacja w ustawie o finansach publicznych, „Finanse Komunalne”, nr 1-2.Sekuła A., 2013, Does the source matter? Generation of investment expenditures by different types of local government revenues, [w:] Local Economy in Theory and Practice. Local Development Governance Aspects, Brol R., Sztando A. (red)., „Prace Naukowe Uniwersytetu Ekonomicznego we Wrocławiu”, nr 283.Skorwider-Namiotko J., 2013, Zmiany w poziomie własnego potencjału inwestycyjnego gmin w okresie niestabilności finansowej, [w:] Finanse i nieruchomości w rozwoju lokalnym i regionalnym, Brol R., Bal-Domańska B. 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Attenuation of Doxorubicin-Induced Cardiotoxicity by mdivi-1: A Mitochondrial Division/Mitophagy Inhibitor.
No full textDoxorubicin is one of the most effective anti-cancer agents. However, its use is associated with adverse cardiac effects, including cardiomyopathy and progressive heart failure. Given the multiple beneficial effects of the mitochondrial division inhibitor (mdivi-1) in a variety of pathological conditions including heart failure and ischaemia and reperfusion injury, we investigated the effects of mdivi-1 on doxorubicin-induced cardiac dysfunction in naïve and stressed conditions using Langendorff perfused heart models and a model of oxidative stress was used to assess the effects of drug treatments on the mitochondrial depolarisation and hypercontracture of cardiac myocytes. Western blot analysis was used to measure the levels of p-Akt and p-Erk 1/2 and flow cytometry analysis was used to measure the levels p-Drp1 and p-p53 upon drug treatment. The HL60 leukaemia cell line was used to evaluate the effects of pharmacological inhibition of mitochondrial division on the cytotoxicity of doxorubicin in a cancer cell line. Doxorubicin caused a significant impairment of cardiac function and increased the infarct size to risk ratio in both naïve conditions and during ischaemia/reperfusion injury. Interestingly, co-treatment of doxorubicin with mdivi-1 attenuated these detrimental effects of doxorubicin. Doxorubicin also caused a reduction in the time taken to depolarisation and hypercontracture of cardiac myocytes, which were reversed with mdivi-1. Finally, doxorubicin caused a significant elevation in the levels of signalling proteins p-Akt, p-Erk 1/2, p-Drp1 and p-p53. Co-incubation of mdivi-1 with doxorubicin did not reduce the cytotoxicity of doxorubicin against HL-60 cells. These data suggest that the inhibition of mitochondrial fission protects the heart against doxorubicin-induced cardiac injury and identify mitochondrial fission as a new therapeutic target in ameliorating doxorubicin-induced cardiotoxicity without affecting its anti-cancer properties
Are hospitalized or ambulatory patients with heart failure treated in accordance with European Society of Cardiology guidelines? Evidence from 12,440 patients of the ESC Heart Failure Long-Term Registry.
No full textAimsTo evaluate how recommendations of European guidelines regarding pharmacological and non-pharmacological treatments for heart failure (HF) are adopted in clinical practice.Methods and resultsThe ESC-HF Long-Term Registry is a prospective, observational study conducted in 211 Cardiology Centres of 21 European and Mediterranean countries, members of the European Society of Cardiology (ESC). From May 2011 to April 2013, a total of 12 440 patients were enrolled, 40.5% with acute HF and 59.5% with chronic HF. Intravenous treatments for acute HF were heterogeneously administered, irrespective of guideline recommendations. In chronic HF, with reduced EF, renin-angiotensin system (RAS) blockers, beta-blockers, and mineralocorticoid antagonists (MRAs) were used in 92.2, 92.7, and 67.0% of patients, respectively. When reasons for non-adherence were considered, the real rate of undertreatment accounted for 3.2, 2.3, and 5.4% of the cases, respectively. About 30% of patients received the target dosage of these drugs, but a documented reason for not achieving the target dosage was reported in almost two-thirds of them. The more relevant reasons for non-implantation of a device, when clinically indicated, were related to doctor uncertainties on the indication, patient refusal, or logistical/cost issues.ConclusionThis pan-European registry shows that, while in patients with acute HF, a large heterogeneity of treatments exists, drug treatment of chronic HF can be considered largely adherent to recommendations of current guidelines, when the reasons for non-adherence are taken into account. Observations regarding the real possibility to adhere fully to current guidelines in daily clinical practice should be seriously considered when clinical practice guidelines have to be written. © 2013 Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2013. For permissions please email: [email protected]
