Chaque forme pharmaceutique présente ses propres avantages et inconvénients acheter du amoxil
mais n'ont pas d'effets néfastes pour l'organisme dans son ensemble.
"To every thing there is a season, and a time to every purpose under the heaven;
A time to be born, and a time to die;
a time to plant, and a time to pluck up that which is planted;
A time to weep and a time to laugh; a time to mourn, and a time to dance;
A time to get, and a time to lose; a time to keep and a time to cast away; "
(Ecclesiastes 3. 1-2, 4, 6)
MAZSIHISZ Szeretetkórházért Foundation
Editor: Hospice Mobil Team
Publisher: Zsuzsanna Deutsch, MD
Chairman, MAZSIHISZ Szeretetkórházért Foundation
Photos: Péter Favics
MAZSIHISZ Szeretetkórházért Foundation
1145 Budapest, Amerikai út 53-55. Hungary
Phone: (36-1) 251 95 68, (36-1) 251 94 78
Fax: (36-1) 251 94 78
Account number: OTP : 11714006 - 20407234
In 1990 the WHO set of recommendation for the palliative care, which is an interventionor cure to alleviate the symptoms. This means a complex way of caring for those patientswho are suffering from serious, advanced and incurable illness or they in a terminal state.
The main aim is to cure the pain and beside this to help to solve the social difficulties
and to give psychological, spiritual and mental care for these patients. The goal of pallia-tive care is to ensure the relative physical well-being of the patients and to maintain thehuman dignity for their remaining days.
One of the main principles of the Hospice care is to improve the quality of these
This means that the care necludes not only looking after the patient's physical needs
but taking care of it's social and mental demands as well as helping the family during theillness and during mourning.
The Hospice service care is free of charge for everyone because all the people have the
right for the dignity of death. The Hospice team is financed by the National HealthInsurance Fund since 1st October 2004. The importance of Sir Israel Sela must be men-tioned have. He gave a great help to start this programme and his view of life showed agreat example how we can keep an active and joyful life even with a dreadful illness.
The Hungarian Jewish Support Fundation accepted these priciples and applied for
grant to the Government of Luxemburg to organize the hospice palliative care at theJewish Charity Hospital and for those patients who receive domiciliary care.
The service became reality when the Government of Luxemburg and the American
Joint granted a funding support to set up a hospice mobile team for two years. This serv-ice has been giving an improvement of the quality of the Jewish elderly people's life.
We are working on to train this team, to provide possibilities of further studies and to
enlarge it volunteers are take part in our work as well.
Our goal is to carry on with this very important service even after the fund of the
Government of Luxemburg has been already used.
Due to this goal the Hospital signed a contract with the National Health Insurance
Fund to carry on with this Hospice service so the future of the Hospice Mobile Team isinsured for a long term.
Our professional work and the high professional standard of Hospice care in our
Hospital is recognized by our patients who were offered to come to us.
"Who saves one life saves the all humanity."
Zsuzsanna Deutsch, MD
Director, Jewish Charity Hospital
Chairman, MAZSIHISZ Szeretetkórházért Foundation
HOSPICE MOBILE TEAM
The hospice service aims to alleviate physical pain, to sooth signs of depression, to easepsychmlogical problems and help to solve social difficulties of terminally ill patients, suf-fering mostly from cancer related diseases. An interdisciplinary team of experts (physi-cians, nurses, psychologists or mental health experts, priests/rabbis, social workers andvolunteers) work together to provide this service. The care of such a multi-professionalteam is able to ensure the relative physical well-being and human dignity of the hospicepatienvs to live out their remaining days.
Over the past 13 years hospice care was provided in different organizational settings
in Hungary. According to the data of the Hungarian Hospice and Palliative Associationcollected, until the end of 2004 an estimated 14, 973 patients have utilized hospice servicein the country. At this time there were 10 in-patient hospice units, 28 hospice home careteams and 4 hospice mobile team. Nursing in the spirit of hospice care is running in sixnursing- and residential homes for elderly. Currently there are 48 hospice type organiza-tions working countrywide. In addition to the already operating forms of hospice care -hospital hospice and palliative wards and home care - numerous hospitals began addingmobile hospice teams to their staffs. The mobile team is a preferable and cost-effectivesolution. Patients get care in their usual environment and the practice does not require set-ting up a separate ward or unit. At the same time mobile care can generate positivechanges in the rather outdated Hungarian health care system.
Within the Hungarian Jewish community there is large number of elderly people.
Hungarian Jewish Social Support Foundation (HJSSF) felt obliged to provide the bene-fits of hospice care parallel to already-existing home nursing and home care programs.
The service became reality in January 2001 when HJSSF was granted funding supportthrough the Government of Luxembourg and the American JOINT. The HJSSFmobile hospice team was set up in coordination with the Charity Hospital of theFederation of Hungarian Jewish Communities in Hungary (Jewish Charity Hospital).
At first the lack of psychologists or social workers empoyed at the hospital caused somedifficulties. The team with completly unfamiliar tasks had to fit into the framework ofthe hospital. It was hard to have our goals and competence accepted. Many time therequirements of the patients, relatives, and hospital staff were beyound the boundariesof the hospice service. Ue found it challenging to integrate into the hospital, because ofthe fact, that our tasks are only collateral, the basic care is provided by the hospital staff.
Our team mediates the hospice spirit and the importance of psychological, and mentalwell-being with the physical comfort. One of our main objectives is to focus on prevent-
ing depression caused by long term hospitalisation. Both patients of the hospital and theterminally ill patients of the hospice team are welcomed at club activities, group phys-iotherapy-programs and cultural programs ( screenings, musical presentations) organ-ized by team. As the result of the supportive and helpful board of MAZSIHISZSzeretetkórházért Foundation we achieved friendly enviroment for the patients in thegarden and in the common-rooms. The cultural programs are financed by the founda-tion as well. On the 1st of October in 2004 Jewish Charity Hospital got financial sup-port from the National Health Insurance Fund for 10 hospice patients. For the past yearwe have been utilizing this funding. That means even closer cooperation wiht the hos-pital staff both in administration and nursing.
Objectives of the mobile team:
1. To provide holistic care and support by an interdisciplinary team to terminally ill
patients and their families, first of all to patients who suffer from tumor related diseases.
2. Offer consultation and advice to staff at the hospital3. Mediation in the spirit of hospice with the goal of shaping future medicine.
Requirements of the operation
1. Each member of the team should receive extensive training, with continuing training
to follow, in the area of hospice/palliative care.
2. Team members should meet once a week for discussion on patient cases and partici-
pate in team supervisions twice a month.
3. Provide documentation of each patient cooperating with the hospital staff, and in our
computer files as well.
4. Admission to-, care in- and dismissal from the hospice ward should happen in consen-
sus with the leadership and the staff of the hospital.
5. Setting up a properly equipped office for the unit inside the hospital.
Current members of the team are:
Veronika Márvány, MD, head of the service, consulting physician (part-time) Ildikó Kecskeméti, clinical psychologist (part-time)Annamária Kôszegi, social worker, mental health expert (part-time)Mónika Máthé, social worker (part-time)Magdolna Nyíri, trained hospice nurse (full-time)Mónika Veress, trained hospice nurse (part-time)
Zsófia Horváth, physiotherapistÁgota Peredi, trained volunteerKatalin Werner, trained volunteer
We have weekly case study discussions with participation of all members of the team
where we exchange information and our experiences related to our patients, develop ourstrategy of hospice care and service. We monitor our experiences and statistics in our com-puter files. The remarks and observation of the team are included in the patient docu-mentation of the hospital as well.
Working with terminally ill patients is emotionally challanging for team mem-
bers. We decided to work with a supervisor in the beginning of 2003. The group orindividual supervision is an effective way to give psychological help for the teammembers. It improves the realtionship between patients and team members, as well ascooperation, and communication among the members of the team. The supervisionhelps to reduce the emotional stress, to develop competency. We attended 3 groupsupervision from the March of 2003 until the June of 2005. We agree that each mem-ber of the team should participate in team supervision. Almost each member workpart-time so this group therapy also gives place to improve relationship among teammembers. Our supervision was financed by the Hungarian Jewish Social Support
Fundation. The aim and purpose of supervision is to help the members cope with andreduce professional strains, improve job satisfaction, motivation, efficiency and pre-vent burn-out syndrome.
During our four years operation many members left our team. Fortunately we were
able to arrange replacement for their position. From the begining to the 6th of January of2004 Katalin Hegedûs PhD and after untill the September of 2005 György Sámuel MDwere the team managers and since than Veronika Márvány MD has been leading the team.
Since the team was founded the members were Vera Békés psychologist, Náthán Raschkasocial worker, György Kósa music therapist, Krisztina Kerekes skilled nurse, SaroltaVeszprémi registered nurse, Csilla Simon Lois registered nurse, Judit Kardos volunteer,Judit Farkas volunteer, Zsuzsa Balogh Vajna volunteer, Veronika Gál volunteer. Thanksfor their time and cooperation.
All hospice team members have participated in the basic and additional hospice cours-
es ( 80 hours). Mónika Veress and Magdolna Nyíri qualified in 2003 as trained hospicenurses and coordinators. Magdolna Nyíri, Mónika Veress and Zsófia Horváth have par-ticipated in bereavement counselor course. Annamária Kôszegi social worker got a Masterdegree as a mental health expert. The title of her thesis is „Importance of Club Activityin Mental Health".
Mónika Veress trained hospice nurse gives lectures regularly as a part of the hospice
basic course about her work.
During the last four year we visited several hospice services such as the Erzsébet
Hospice in the City of Miskolc and the Hospice House in Budapest.
The team also works as a methodological center. Many organizations and private per-
sons seek our opinion and advice in related issues. We have presented our hospice workto numerous delegations from abroad and many delegations from Hungary. Our guestswere among others Nancy Goodman, American ambassador, Zsuzsa Ferge professor ofsociology at Eötvös Lóránd University, the board of JOINT, Mary Callaway, manager ofOpen Society Institute from New York, and Dr. Carl Johan Fürst and Sylvia Sauter,directors of EAPC- East.
We trained students of Nursing Schools (skilled hospice nurses) from Pécs and
Budapest, students of Social Assistant Schools from Gyôr and from Esztergom, severalhospice services from Hungary, students of ORZSE, and registered nurses from Sweeden.
12 trained hospice nurse and 8 social workers have done internships in our hospice.
"The mobile hospice team based in the Jewish Charity Hospital is one of the palliative
care ‘beacons' in Eastern Europe. The beacons provide good models for service innova-tion, partnership approaches and successful use of international mechanism of support."
Transition in End of Life Care. Hospice and related developments in Eastern Europe andCentral Asia. (Report for the Open Society Institute, New York, May 2002)
Admission to the hospice service
Admission to the hospice ward should happen in consensus with the director of the hos-pital, Zsuzsanna Deutsch, MD. The patient eets the regular care on the ward. The doctorrequesting hospice care fills out the patient registration form and indicates the nature ofcare expected (psychological, social, nursing, etc.). The members of the team provide thehospice care beyond the regular care. The remarks and observation are discussed in week-ly team consultations. The team informs the hospital staff as well.
ACTIVITIES OF HOSPICE MOBILE TEAM March 2001 – July 2005
Our team provided care for 382 patients, altogether on 11 573 occasions. Of our patients,246 suffered from a tumor-related disease. During this period 180 of our patients died. Theothers left the program and were subsequently cared for by a nursing home or were trans-ferred to another institution.
Nursing activitiesNursing care for 223 patients on 5067 occasions (average one hour per patient).
Tasks: ensure physical and psychological comfortPhysical care: medication to ease pain (as prescribed by hospice doctor), treatment ofulcers, phototreatments by Bioptron lamp, bloof pressure checks, monitoring pulse andblood glucose levels, regular mouth hygiene, nail cutting, massage, calisthenics, bladdercontrol, regular diaper-changing. Psychological care: psychological support by listening and helping to cope with bereavement.
Social WorkCare for 219 patients on 1842 occasions (average one hour per patient)Tasks: deal with legal issues and restitution cases, manage correspondence and bankingerrands; arrange" home nursing specialists; order meals-on-wheels service; contact rela-tives, mediate services; apply for financial aid; supply items such as a tape recorder andearphones; celebrating birthdays, etc.
Psychological and Mental Health CareCare for 174 patients on 1443 occasions (average ole hour per patient)Tasks: listen attentively, help the patient reviewing and evaluating his/her life, advisementon current problems, coping with depression, oppression and paranoia, discussion of spir-itual issues, consultations with family members, help with various hobbies such as writ-ing and reading.
Volunteer care 8 volunteers have helped 44 patients on 1105 occasions since March of 2001.
CLUB ACTIVITIES AND CULTURAL PROGRAMSORGANIZED BY HOSPICE MOBILE TEAMMarch 2001 – July 2005
Club activitiesThere have been club activities once a week on numerous occasions at Ward 2. sinceMarch of 2002, at Ward 1. since July of 2004, and at Ward 3. since the middle of June of2005. The leaders of this activity are Annamária Kôszegi and Mónika Máthé social work-ers. In the course of club activities there are regular group physiotherapy, quiz programs,film club, Scrabble, etc.
Screenings The program includes mostly old movies, operas, musical comedies. Comedies, dramas,plays and even cartoons are recieved warmly. We respect the patients' requirements.
Talk shows, presentations and lecturesAmong our guests were Imre Antal enterteiner, Judit Hernádi actress, József Sass come-dian, József Székhelyi actor. There were several lectures in relation to the history of musicby György Kósa music therapist and lectures on history of art by Zsolt Schweckhardt.
Clown doctors "Piros Orr" entertained our patients several times.
Concerts, musical presentationsMónika Veress has invited several artist for the last years. Among others we invitedLászló Fekete precentor, Endre Kertész, Gryllus Dániel és Gryllus Vilmos, Balogh Józsefés Zsákai Ferenc musicians. János Kulka actor, singer, Júlia Vaig, Tamás Migróczi,DóraMigróczi, Judit Brüg and Miklós Budai musicians entertained our patients at our gardenconcerts. Our regular guest are JOFI band (jewish folk music), Ádám Fellegi pianist, PéterBerentei singer.
Religious HolidaysWe celebrate the Jewish Holidays ( Pesah, Shavuot, Rosh ha-Shanah, Sukkot, Hanukkah,Purim, Tu Bishvat, Yom ha- Atzma' ut) in every year cooperating with Tamás Róna rab-binical student, László Davidovics, rabbinical student and the chorus of Scheiber SándorHigh School.
Tendering operation of hospice Mobile team together with MAZSIHISZSzeretetkórházért foundation and hungarian jewish social support FoundationMarch 2001 – July 2005
The hospice mobile team is not a legal person, therefore, we applied together with a foun-dation.
Technical investments (microphones, synthesizers, amplifier, speakers)
Fee of bereavement counselor course for two member of the team
Registration fee, travel expenses, accommodation for the team at Hungarian HospiceCongress, Miskolc
Registration fee, travel expenses, accommodation for two member of the team atEuropean Association for Palliative Care VII.
Film about the Jewish Charity Hospital and about our hospice mobile team
Financing 4 concerts and musical presentations
Financing 2 TV sets, 2 DVD players
Garden furniture, curtains in the common-rooms
Financing 8 concerts and musical presentations
Supervision for the nurses and physicians at the hospital
Supervision for the hospice mobile team
Booklet about the hospice mobile team
Jewish Charity Hospital Hospice Mobile Team
Head of the service: Veronika Márvány, MD
Amerikai út 53-55.
Phone/Fax: (31-1) 468-23-62
Physical Therapy Treatment Effectiveness forOsteoarthritis of the Knee: A Randomized Comparison of Supervised Clinical Exercise and Manual Therapy Procedures Versus a Home ProgramGail D Deyle, Stephen C Allison, Robert L Matekel,Michael G Ryder, John M Stang, David D Gohdes, Jeremy P Hutton, Nancy E Henderson and Matthew BGarberPHYS THER. 2005; 85:1301-1317.
Clinical Effectiveness Programme SDcep Drug Prescribing For Dentistry Dental Clinical Guidance Clinical Effectiveness Programme SDcep The Scottish Dental Clinical Effectiveness Programme (SDCEP) is an initiative of the National Dental Advisory Committee (NDAC) and is supported by the Scottish Government and NHS Education for Scotland. The programme aims to provide user-friendly, evidence-based guidance for the dental profession in Scotland.