I'm student of University of Debrecen - one of Hungary’s five research-elite universities. It offers the widest choice of majors in the country for over 32,000 students. It has 1500 lecturers of 15 faculties endeavour to live up to the elite university status and to provide high quality education for those choosing the University of Debrecen every day.
The University of Debrecen is a dynamically expanding institution.
I believe in power of social media and I'm so glad my University has embraced it too. It has an official Facebook page where they post newest education or sport news (they have 18.863 followers, which is not too bad). For the fastest information you can follow their Twitter page. If you like videos or simply you missed some events, you can catch up on their official Youtube channel. In other universities (e.g. Cardiff University) these tools are evident, but, unfortunately not all universities in Hungary understand the value of them.
The University of Debrecen tries to keep up with revolution of social media. Encourage your university to do the same!
Itraconazole is an antifungal drug used widely to treat fungal infections and is active against Aspergillus, Candida and Cryptococcus. It is effective and now much cheaper as it has passed out of the period of time granted to its inventor to exclusively sell it - there are now several competing manufacturers. It seems to be an increasingly useful and used drug now it has become more accessible which is a good thing in the main but this makes it increasingly important that this drug is properly understood and its very severe potential side effects appreciated and guarded against.
These are the warnings published by the World Health Organisation
Risk of congestive heart failure
The agency says that while the available evidence suggests that the risk of heart failure with short courses of itraconazole is low in healthy, young patients, prescribers should exercise caution when prescribing the drug to at-risk patients. Amendments to the product information of all itraconazole formulations have been made to reflect this information.
Risk to pregnant women
By April 2000 the UMC had received 43 case reports from 5 countries regarding the use of itraconazole by pregnant women. 25 of these pregnancies ended in embryonic or foetal death. The remaining 19 reports described a variety of congenital malformation or neonatal disorders. In the 38 reports in which the route of administration was specified the drug was taken orally. The data suggested that:
inspite of the approved recommendations and warnings itraconazole is being taken by pregnant women for minor indications,
reported human experience seems to lend support to the experimental evidence that itraconazole is teratogenic,
there is a predominance of abortion, and
more firm warnings may be needed in the product information.Although not apparent from the UMC reports, a further question of interest was if itraconazole might decrease the reliability of oral contraceptives and so lead to unintended exposure in pregnancy.
Care thus needs to be taken about which patients are prescribed itraconazole, adequate monitoring needs to be put in place if needed and sufficient advice given with the drug to ensure the patient is aware of the risks involved and the signs & symptoms to look out for.
By Genevieve Yates
One reason why I chose to do medicine was that I didn’t always trust doctors – another being access to an endless supply of jelly beans. My mistrust stemmed from my family’s unfortunate collection of medical misadventures: Grandpa’s misdiagnosed and ultimately fatal cryptococcal meningitis, my brother’s missed L4/L5 fracture, Dad’s iatrogenic brachial plexus injury and the stuffing-up of my radius and ulna fractures, to name a few.
I had this naïve idea that my becoming a doctor would allow me to be more in charge of the health of myself and my family. When I discovered that doctors were actively discouraged from treating themselves, their loved ones and their mothers-in-law, and that a medical degree did not come with a lifetime supply of free jelly beans, I felt cheated. I got over the jelly bean disappointment quickly – after all, the allure of artificially coloured and flavoured gelatinous sugar lumps was far less strong at age 25 than it was at age 5 – but the Medical Board’s position regarding self-treatment took a lot longer to swallow.
Over the years I’ve come to understand why guidelines exist regarding treating oneself and one’s family, as well as close colleagues, staff and friends. Lack of objectivity is not the only problem. Often these types of consults occur in informal settings and do not involve adequate history taking, examination or note-making. They can start innocently enough but have the potential to run into serious ethical and legal minefields. I’ve come to realise that, like having an affair with your boss or lending your unreliable friend thousands of dollars to buy a car, treating family, friends and staff is a pitfall best avoided.
Although we’ve all heard that “A physician who heals himself has an idiot for a doctor and a fool for a patient”, large numbers of us still self-treat. I recently conducted a self-care session with about thirty very experienced GP supervisors whose average age was around fifty. When asked for a show of hands as to how many had his/her own doctor, about half the group confidently raised their hands. I then asked these to lower their hands if their nominated doctor was a spouse, parent, practice partner or themselves. At least half the hands went down. When asked if they’d seek medical attention if they were significantly unwell, several of the remainder said, “I don’t get sick,” and one said, “Of course I’d see a doctor – I’d look in the mirror.”
Us girls are a bit more likely to seek medical assistance than the blokes (after all, it is pretty difficult to do your own PAP smear – believe me, I’ve tried), but neither gender group can be held up as a shining example of responsible, compliant patients. It seems very much a case of “Do as I say, not do as I do”. I wonder how much of this is due to the rigorous “breed ’em tough” campaigns we’ve been endured from the earliest days of our medical careers. I recall when one of my fellow interns asked to finish her DEM shift twenty minutes early so that she could go to the doctor. Her supervising senior registrar refused her request and told her, “Routine appointments need to be made outside shift hours. If you are sick enough to be off work, you should be here as a patient.” My friend explained that this was neither routine, nor a life-threatening emergency, but that she thought she had a urinary tract infection. She was instructed to cancel her appointment, dipstick her own urine, take some antibiotics out of the DEM supply cupboard and get back to work. “You’re a doctor now; get your priorities right and start acting like one” was the parting message.
Through my work in medical education, I’ve had the opportunity to talk to several groups of junior doctors about self-care issues and the reasons for imposing boundaries on whom they treat, hopefully encouraging to them to establish good habits while they are young and impressionable. I try to practise what I preach: I see my doctor semi-regularly and have a I’d-like-to-help-you-but-I’m-not-in-a-position-to-do-so mantra down pat. I’ve used this speech many times to my advantage, such as when I’ve been asked to look at great-aunt Betty’s ulcerated toe at the family Christmas get-together, and to write a medical certificate and antibiotic script for a whingey boyfriend with a man-cold.
The message is usually understood but the reasons behind it aren’t always so. My niece once announced knowledgably, “Doctors don’t treat family because it’s too hard to make them pay the proper fee.” This young lady wants to be a doctor when she grows up, but must have different reasons than I did at her age. She doesn’t even like jelly beans!
Genevieve Yates is an Australian GP, medical educator, medico-legal presenter and writer. You can read more of her work at http://genevieveyates.com/
Cultural change could be just what's needed
All of us, at some time, will have experiences of being a patient. At such times we might feel vulnerable as we look to doctors, nurses and other healthcare professionals for help and advice.
While most of our experiences will be positive, a significant minority of us will experience difficulties in our interactions with healthcare professionals. For example last year, following a spate of similar reports across the UK, the Older People's Commissioner for Wales found consistent issues concerning the lack of dignity and respect patients received in hospital.
These situations can cause real distress for patients, undermine the effectiveness of clinical treatment and sometimes impacts on how fast we might recover.
I am interested in how this state of affairs comes about within an NHS that promotes respect, dignity and compassion for all. My research examines what happens to healthcare students during their training in clinical settings that means they sometimes have to be reminded that the person in front of them is a human who deserves compassion and respect.
Today's healthcare students are explicitly taught about what comprises professional values and behaviours. However, a large part of learning to become a healthcare professional occurs within the NHS as they observe their seniors – who act as powerful role models – interacting with patients. Sometimes these role models were trained many years ago and belong to a different culture of medicine with different ways of doing things.
People who belong to the same cultural group tend to embrace common characteristics such as language, customs and values. In doing this they embrace a common "cultural identity" and achieve a sense of belonging.
Likewise, healthcare students tend to embrace common characteristics of their chosen profession. They look to their seniors for guidance about how to behave. But what if their seniors belong to a different era where things that were acceptable then may no longer be acceptable now?
One strand of my research examines professionalism dilemma situations. These are situations in which healthcare students find themselves witnessing or participating in something unethical or unprofessional. These include witnessing, and sometimes participating in, breaches of patient safety and dignity.
Students often report experiencing distress in such situations as they know the right way to behave, but feel unable to do so for some reason. In their stories, students frequently report feeling unable to speak out for fear of receiving poor grades as their seniors are also their teachers, because they are low in the pecking order or because speaking out might hamper their future career.
So how can we support tomorrow's healthcare students to become ethical and compassionate professionals?
Revalidation for doctors is coming into force and involves patient and colleague feedback. But our research suggests that, by itself, this is insufficient to change behaviours.
We urge healthcare schools to provide students with a safe place to share their stories with each other and with ethical role models so they can begin to make sense of their experiences, share good practice and ways to resist bad practice. Most of all, we suggest that cultural change should occur from within. Patients, patient advocates, students and healthcare professionals should join together to examine how language, practices and values occurring within clinical settings can be developed to improve patient safety and dignity for all.