Covid-19: naše izkušnje in analiza kakovosti akutne obravnave

V času epidemije covida-19 so se v zdravljenje bolnikov s covidom v Sloveniji vključevale različne slovenske bolnišnice. Ob centralno koordiniranem vključevanju – glede na potrebe in zmogljivosti bolnišnice ter ob upoštevanju strokovne usmerjenosti posameznih bolnišnic – so bile izkušnje ustanov različne. V prispevku prikazujemo izkušnje z obravnavo bolnikov s covidom-19 v obdobju 4. vala epidemije v periferni, pulmološko usmerjeni bolnišnici, kar je prvi prikaz analize kakovosti obravnave teh bolnikov v Sloveniji. Osnovne značilnosti hospitalizacij smo analizirali s pomočjo integriranih rešitev informacijskega sistema Birpis in pregleda elektronske temperaturno-terapevtske liste (eTTL). Kakovost strokovne obravnave smo ocenjevali glede na upoštevanje veljavnih strokovnih priporočil. Analiza je potekala z vgrajenimi statističnimi funkcijami programa Microsoft Excel. 99 bolnikov (58 žensk, 41 moških), starih 67,9 leta, je bilo v povprečju hospitaliziranih 8,1 dneva. Večina so bili prebivalci naše regije (61 %), necepljeni (61,6 %) in s težkim potekom bolezni s potrebo po dodatku kisika (88,9 %). Večina bolnikov je prejela steroide (73,7 %), antibiotik (68,7 %) in vitamin D (71,7 %), v manjši meri so prejeli specifično terapijo (remdesivir 25,3 %, kombinacijo kasirivimab/imdevimab 2 %, tocilizumab 1 %). Neželenih učinkov novih zdravil nismo zabeležili. Umrlo je 17 oseb (celokupna smrtnost 17,2 %). Med osebjem na covidnem oddelku ni prišlo do prenosa okužb. Rezultati kažejo, da je bilo zdravljenje bolnikov s covidom-19 v Bolnišnici Topolšica uspešno, hkrati pa nakazujejo možnost dodatnih izboljšav zlasti na področju predpisovanja antibiotikov

Predlog za obravnavo bolnika z astmo na primarni in pulmološki specialistični ravni v Sloveniji

Z dokumentom želimo smernice, ki jih predlaga GINA, vključiti v slovenski prostor. Želimo, da bi dokument služil enotnemu in dogovorjenemu pristopu k obravnavi bolnikov z astmo na primarni in specialistični pulmološki ravni

INDEPENDENT NON-ACUTE CARE – INDISPENSABLE PART IN COMPLETE NURSING HEALTH CARE

First experience with organisation and operation of nurse-led intermediate care department in Slovenia is presented. Organisation of independent non-acute care department led to 5% shortening in average length of stay in acute care and 16% decrease in rehospitalization rate. Majority (61.9%) of the patients admitted to the intermediate care department were discharged to their homes, 10.9% to homes for aged people, 7% to other institutional care facilities or departments for long term care, and 9.6% died. After discharge 43% of the patients were independent, 23% managed with some help, and 34% were totaly dependent from help by others. By adaptive programmes of training a success was made by involving next kins and guardians in care for the patients at home. Better economy was achieved by lowering over-head and diagnostic costs (23% of average acute – care department diagnostic cost).<br /><br /

Therapeutic success of tiotropium/olodaterol, measured using the Clinical COPD Questionnaire (CCQ), in routine clinical practice: a multinational non-interventional study /

Background: The Clinical COPD Questionnaire (CCQ) is a simple patient-reported tool to measure clinical control of chronic obstructive pulmonary disease (COPD). Objective: This open-label, single-arm, non-interventional study (NCT03663569) investigated changes in CCQ score during treatment with tiotropium/olodaterol in clinical practice. Methods: Data were included from consenting COPD patients, enrolled in Bulgaria, Czech Republic, Hungary, Israel, Lithuania, Poland, Romania, Russia, Slovenia, Switzerland and Ukraine, who were receiving a new prescription for tiotropium/olodaterol according to the treating physician in a real-world environment. The primary endpoint was the occurrence of therapeutic success, defined as a 0.4-point decrease in CCQ score after treatment with tiotropium/olodaterol for approximately 6 weeks. Results: Overall, 4819 patients were treated; baseline and Week 6 CCQ scores were available for 4700 patients, mostly classified as Global Initiative for Chronic Obstructive Lung Disease (GOLD) B (51.6%) or D (42.7%). After 6 weeks’ treatment, 81.4% (95% confidence interval [95% CI] 80.24–82.49) of patients achieved therapeutic success; mean improvement in overall CCQ score was 1.02 points (95% CI 1.00–1.05). Improved CCQ score was seen in 92.2% of patients (95% CI 91.43–92.98), 2.5% had no change and 5.3% showed a worsening. When stratified by prior treatment, the greatest benefit was seen in treatment-naïve patients, with 85.7% achieving therapeutic success, compared with 79.5% of those pretreated with long-acting β2-agonist (LABA)/ inhaled corticosteroid (ICS) and 74.2% of those pretreated with LABA or long-acting muscarinic antagonist (LAMA) monotherapy. Overall, rescue medication decreased by 1.25 puffs/day (95% CI 1.19–1.31) versus baseline. In total, 29 patients (0.6%) reported drug-related adverse events and 7 patients reported serious adverse events (0.15%). Conclusion: In 4700 COPD patients, 6 weeks’ treatment with tiotropium/olodaterol, as initial treatment or follow-up to LAMA or LABA monotherapy or LABA/ICS, improved CCQ and decreased rescue medication use. The adverse event profile was consistent with the known safety profile of tiotropium/olodaterol

Position on the follow-up of patients after a bout of COVID-19 pneumonia

Pljučnica je najpogostejši vzrok za težji potek okužbe z virusom SARS-CoV-2 in s hospitalizacijo. Potek covidne pljučnice je lahko različeninfiltrati, vidni na rentgenski sliki, se lahko resorbirajo spontano, včasih pa je potrebno zdravljenje s sistem-skimi glukokortikoidi. Ob odpustu iz bolnišnice zdravljenje običajno še ni končano, zato je Združenje pulmologov Slovenije v želji po enotnem obravnavanju bolnikov s covidno pljučnico izdelalo mnenje za obravnavo in sledenje bolnikov po od-pustu iz bolnišnice. Zavedamo se, da ob novi bolezni ne gre za dokončno priporočilo, saj bodo nova spoznanja o covidni pljučnici zanesljivo zahtevala obnavljanje priporočil.Pneumonia is the most common complication of SARS-CoV-2 infection. Covid 19 - pneumonia is a serious illness and can lead to respiratory failure. Pulmonary infiltrates often resorb spontaneouslyhowever, sometimes treatment with systemic glucocorticoids is required. Upon discharge from the hospital, treatment is usually not yet completed. The Slovenian Respiratory society made suggestions for the treatment and follow-up of patients with covid 19 pneumonia after discharge from hospital. We are aware that with new findings we will need to update these recommendations