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Hyponatremia is a very common abnormality in palliative care which can cause a sudden decline in the patient's general condition. The diagnostic and therapeutic procedures are based on the patient's symptoms and life-expectancy. The inadequate diagnostic and therapeutic interventions result in an unnecessary burden, while the adequate treatment could improve the quality of life. In palliative care, acute hyponatremia is very rare, the chronic form without any symptoms or mild complaints is more common. Asymptomatic patients should be observed. In patients with mild symptoms and months or years plus prognosis contributing factors should be discontinued. The electrolyte abnormality of patients with moderate or severe symptoms and at least weeks prognosis should be treated. Patients with day prognosis needs no treatment. This case report of an early palliative care patient with moderate symptoms caused by chronic, severe hyponatremia aims to give a suggestion for the management of the most common electrolyte abnormality in everyday palliative care. Orv Hetil. 2023; 164(18): 713-717.

Introduction: The prevalence of diabetes mellitus is increasing worldwide. According to Hungarian data from 2014, it affects 7,3% of the population. At the time of their cancer diagnosis, 8-18% of all patients have preexisting diabetes mellitus. Some studies have identified a diabetes prevalence up to 30% of cancer patients. The treatment of diabetic patients in palliative care differs from the curative methods and this is very important to be communicated with the patient, the family members and health-care providers. Objective: The aim of this publication is to develop a method of control and treatment of the palliative care patients with diabetes mellitus. Method: Based on studies in international literature, a suggestion can be made that can be applied in domestic practice. Suggestions: This suggestion introduces individual and more liberal control and management methods for a better quality of life in this special patient group. Conclusion: The suggestion for the treatment of diabetes helps provide quality care for palliative patients.

Összefoglaló. A palliatív ellátás célja a beteg és családja életminőségének javítása egy életet megrövidítő betegség során. A palliatív betegpopuláció 32-80%-a kap szisztémás szteroidot kínzó tünetek enyhítésére. Az alkalmazási irányelvek, a szteroidhasználat a palliatív betegek körében nagyon változó az egyes országok, de az országon belüli ellátók között is. A palliatív betegellátásban szteroidokat - elsősorban szisztémás glükokortikoidokat (dexametazon, betametazon, prednizolon, metilprednizolon) - főleg antiinflammatorikus és a vascularis permeabilitást csökkentő hatásuk miatt alkalmazunk. A palliatív ellátás során glükokortikoid adása számos specifikus indikáció esetén javasolható, mint idegi kompresszió, neuropathiás fájdalom, csontfájdalom és metastasis, májtokfeszülés okozta fájdalom, malignus bélobstrukció, agynyomás-fokozódás, malignus gerincvelő-kompresszió, vena cava superior szindróma, lymphangitis carcinomatosa, nagy légúti obstrukció. Sokszor párhuzamosan jelentkező, nem specifikus tünetek - mint anorexia-cachexia szindróma, hányinger, hányás, fáradtság, gyengeség, nehézlégzés - szintén szükségessé tehetik szteroid adását. A palliatív betegek prognózisát figyelembe véve a szteroidok késői mellékhatásai nem korlátozzák adásukat, az elsődleges terápiás előny felülmúlja a lehetséges kockázatokat. A nemzetközi gyakorlatban a dexametazon a leggyakrabban alkalmazott glükokortikoid, kifejezett gyulladáscsökkentő hatása és kevesebb mineralokortikoid-mellékhatása miatt. Fontos, elengedhetetlen része a biztonságos szteroidterápiának a mellékhatások gondos monitorozása, erről a beteget és a hozzátartozókat is fel kell világosítani. A megfelelő indikációban, dózisban és megfelelő kezelési terv alapján adagolt szteroid hasznos része a palliatív tünetkontrollnak, a beteg életminőség-javításának. Orv Hetil. 2022; 163(8): 294-300. Summary. Palliative care aims to improve the quality of life of patients and their families during a life-shortening illness. 32-80% of the palliative patient population receive systemic steroids to relieve torturous symptoms during end-of-life care. Guidelines for steroid use among palliative patients vary widely from country to country, but also within providers. In palliative care, steroids - mainly systemic glucocorticoids (dexamethasone, betamethasone, prednisolone, methylprednisolone) - are used especially for their anti-inflammatory and vascular permeability-reducing effects. Glucocorticoid administration during palliative care is recommended for a number of specific indications, such as neural compression, neuropathic pain, bone pain and metastasis, liver capsule pain, malignant intestinal obstruction, increased cerebral pressure, malignant spinal cord compression, superior vena cava syndrome, carcinomatous lymphangitis, and large airway compression. Often concomitant non-specific symptoms such as anorexia-cachexia syndrome, nausea, vomiting, fatigue, weakness, dyspnoea may also necessitate steroid administration. Considering the prognosis of palliative patients, the late side effects of steroids do not limit their administration, the primary therapeutic benefit outweighs the potential risks. Internationally, dexamethasone is the most commonly used glucocorticoid due to its pronounced anti-inflammatory effect and fewer mineralocorticoid side effects. Careful monitoring of side effects is an important and essential part of safe steroid therapy and should be made clear to the patient and their relatives. Steroids administered in the right indication and dose as well as according to an appropriate treatment plan are useful parts of palliative symptom control and improve patients' quality of life. Orv Hetil. 2022; 163(8): 294-300.

Összefoglaló.Bevezetés: Az európai országok közül Magyarország a colorectalis daganatos incidencia és mortalitás szempontjából az élen szerepel. Ennek hátterében a beteghez vagy az egészségügyi rendszerhez köthető tényezők is állhatnak. Célkitűzés: Kutatásunk célja, hogy pilotvizsgálat keretében feltárjuk a colorectalis daganatos betegek kezeléshez jutásának körülményeit azáltal, hogy a betegek első tünetei, kivizsgálásuk jellemzői, betegségük stádiuma és a terápiáig eltelt időtartamok közötti összefüggéseket elemezzük. Módszer: Retrospektív adatgyűjtés történt 26, Baranya megyei háziorvosi praxis colorectalis daganatos betegeinek (n = 212) adataira vonatkozóan a praxisok, valamint a Pécsi Tudományegyetem Klinikai Központjának (PTE KK) adatbázisából. Meghatároztuk a terápiáig eltelt intervallumot (TEI), amely az első orvos-beteg találkozástól - amikor a beteg colorectalis daganatra utaló tünetekkel először jelentkezett orvosnál - a terápia megkezdésének első napjáig eltelt időt jelenti. A statisztikai elemzés során deskriptív analízist, valamint varianciaanalízist végeztünk. Eredmények: A sürgősségire került betegek leggyakoribb tünete a hasi/végbéltáji fájdalom volt, míg a háziorvost felkereső betegek a véres székletet említették a legtöbbször. A sürgősségi osztályon jelentkező betegek esetében lényegesen magasabb arányban (61%) diagnosztizáltak késői (III-IV.) stádiumú daganatot, mint a háziorvoshoz forduló betegek körében (42,7%). A TEI rövidebb volt, ha a betegek sürgősségi osztályra kerültek (TEI-medián: 15 nap késői, 34,5 nap korai [I-II.] stádiumú daganat esetén), mint amikor háziorvosnál jelentkeztek először (TEI-medián: 86 nap késői, 83 nap korai stádiumú daganat esetén). Következtetés: A sürgősségi és a háziorvosi kivizsgálás esetén észlelt TEI-k összemérhetők a nyugat-európai országokéival. A hazai magas mortalitási mutatók hátterében inkább a betegek késedelmes orvoshoz fordulása állhat, ami a primer és szekunder prevenció fontosságára hívja fel a figyelmet. Orv Hetil. 2021; 162(4): 153-160., Introduction: Hungary has one of the leading colorectal cancer incidence and mortality rates in Europe. Patient-related and healthcare-related factors may all play a role., Objective: Our objective was to investigate the characteristics related to the treatment of colorectal cancer patients by analysing their initial symptoms, disease stage, referral characteristics and total treatment intervals., Method: A retrospective study was conducted based on data from colorectal patients (n = 212) from the databases of 26 general physician practices and the University of Pécs, Clinical Center. The total treatment interval was determined as the number of days from the first patient-physician consultation with symptoms until the first day of treatment. Descriptive analysis and analysis of variance were performed., Results: Patients' most common symptom was abdominal/rectal pain when presenting at the emergency department while bloody stool was the most common among patients visiting their general physicians. The proportion of patients with advanced stage (III-IV) cancer was significantly higher at the emergency department than among patients visiting their general physicians (61% and 42.7%, respectively). The total treatment interval was shorter when patients presented at the emergency department (total treatment interval median: 15 days for advanced stage, 34.5 days for early [I-II] stage cancer) than when they initially visited their general physicians (total treatment interval median: 83 days for early stage, 86 days for advanced stage cancers)., Conclusion: The total treatment intervals for patients visiting the emergency department or their general physicians were similar to those found in Western European countries. The high mortality rates in Hungary are more probably due to patient-related delays, which highlight the importance of primary and secondary prevention. Orv Hetil. 2021; 162(4): 153-160.

Introduction: Palliative, symptomatic and end-of-life care of advanced and metastatic cancer patients is a great challenge for every health care system. With the initiation and establishment of the multidisciplinary palliative tumor board (MPTB), our aims were the timely referral of patients to palliative care, and the avoidance of multiple unnecessary emergency visits and over-diagnostics without further treatment consequences., Method and Results: The MPTB meetings were held biweekly. The core members of the team were: palliative care consultant, medical oncologist, internal medicine physician, psychologist, psychiatrist, and oncology and palliative medicine nurses. From May 2019 till January 2020, we discussed the medical history of 97 cases of 93 cancer patients with advanced disease states; in one meeting the team usually discussed over 6-10 complex patient histories. In every case we determined the actual form of the necessary palliative care, e.g., outpatient clinic, home care, or institutional referral, and we decided on further possible and realistic oncology treatment regimes. A few months after the introduction of the new MPTB, we detected a decrease of the unnecessary emergency unit referrals considering the patients whose histories were discussed., Conclusions: Although the initial MPTB discussions had an intense emotional tone, they shortly became thoughtful and operational expert meetings. We believe that the MPTB system fully promotes the early and timely access of advanced cancer patients to appropriate palliative care and facilitates gradual changes in the medical oncologists' approach from the absolute curative determination to a supportive medical attitude. Orv Hetil. 2020; 161(34): 1423-1430.

At the advanced stage of serious illness, end-of-life decisions need to be made. Advance care planning offers patients the right to decide on their own future care when independent decision-making is no longer possible. The most complex and effective advance care plans include patients' preferred or refused medical treatments, care-related wishes, and individual values as well. Advance care planning can improve end-of-life care and contribute to higher satisfaction. It can also reduce distress in relatives and the costs of care. Patients' preferences provide a guidance for professional care. A number of studies have identified the benefits of advance care planning, and it has been included in guidelines. Potential barriers to advance care planning could be as follows: taboo of talking about dying, negative attitudes of patients and relatives, poor knowledge of professional caregivers, lack of necessary circumstances to have the conversation. Advance care planning is almost unknown in Hungary, although it is possible to refuse certain types of treatments. Cooperation of professionals, development of gradual and postgraduate trainings, and improvement of social awareness are also needed so that advance care planning can be adapted in Hungary. Orv Hetil. 2018; 159(4): 131-140.

Purpose: The general purpose of TELL ME study was to give an insight into the experiences of European family physicians with management of H1N1 pandemic flu., Methods: Qualitative research methods (focus group discussions, one-to-one interviews, and online data collection) were used to explore family doctors' opinion and suggestions. Overall 158 family physicians took part in the study from six European countries., Results: Family doctors' most important experience was that the official campaign was not able to compensate negative effects of the mass media. Due to the poor evidence-based information about new vaccines, it was difficult to convince the public and some health care professionals too. Lack of unified directives - under unclear circumstances - made the routine patient care more difficult and hampered the collaboration between different health care providers. Family physicians felt a pressure from health authorities to achieve high immunization rate, but got only a little support from them. Despite the difficulties, vaccination program was a success, mainly among high-risk population. For better handling of a future pandemic, Hungarian family physician made many general and practical suggestions.

Malignant and other chronic diseases cause the death of 2.5 million people in Europe annually. It is anticipated that this number will grow due to the aging of the European population. The death of a significant proportion of patients having progressive chronic disease is preceded by an extended end of life stadium. In this stage the patients have severe symptoms and pain that necessitate their symptomatic treatment and palliative care. The assessment of the life expectancy of patients, estimation of the prognosis of their illness and, therefore, selection of patients with a need of intensified palliative care often pose difficulties. This paper provides a summary on the basic elements of "good palliative care". It introduces the most frequent models for the procession of chronic diseases and those indicators that help practicing doctors to recognise easier patients with a need of intensified palliative care, and as a result provides more adequate medical attendance that is better suited to the specific needs of the patients.

Grief is a natural part of life and it is always individual. Researchers have tried and still try to develop different theories to interpret, explain, and approach this particular phenomenon. The aim of the authors was to review the theoretical literature of mourning and to present new bereavement theories for domestic professionals. From the first half of the 20th century until presently mourning theories have undergone significant changes. Today the determinant models includes the flexible, coping-oriented dual process model, meaning reconstruction model which focuses on the meaning making, and the model which focuses on the development after the loss. The authors conclude that experts, who work in the clinical area should know the prevailing theories of grief, because they encounter often with loss at work. The presented models may contribute to more efficient work, to better understanding of the mourning process and to a better support of families.

Short acting oral morphine has recently been registered again in Hungary. Short acting oral morphine has two essential indications: dose titration at initiation of major analgesic therapy and treatment of breakthrough pain appearing beside round the clock major analgesic therapy. The clinical management of short acting oral morphine is summarised in this article.

Introduction: Death and dying are still taboo topics in Hungary. The care of the dying, the adequate relief of their symptoms and the psychosocial support of both patients and their caregivers are not yet well addressed., Aims: Authors obtained information about the feelings and thoughts of patients on death and dying, and about their expectations for end-of-life care., Methods: Mailed questionnaire was send to a convenience sample of 29 adult primary care offices where a total of 845 unselected patients completed the questionnaire., Results: More than two thirds (69%) of respondents would like to receive end of life care in their home. Only 19% of respondents would prefer to die in a hospital. Respondents' greatest fear was to lose their autonomy (55%). The second most noted concern was fear from pain (38%). According to 93% of the participants, truth telling is very important in the event of terminal illness., Conclusions: Hungarian patients prefer to receive end of life care in their home. Our data support the need for improvement in three primary areas, physician communication skills, pain and symptom management, and expansion of home hospice care.