CARE QUALITY FOR PATIENTS WITH CORONARY ARTERY DISEASE IN FAMILY MEDICINE - GUIDELINE IMPLEMENTATION BY TAKING A GLANCE AT THE RISK FACTORS

Uvod: Bolesnici s koronarnom bolešću su velik izazov u skrbi liječnika obiteljske medicine (LOM) zbog brojnih komorbiditeta te primjene mjera sekundarne prevencije kojima se prate i istovremeno korigiraju rizični čimbenici koji se odnose na bolesnika, njegovu okolinu i stil života. Cilj: Istražiti uspješnost LOM-a u primjeni mjera sekundarne prevencije kardiovaskularnih bolesti i pronaći moguće rješenje za poboljšanje kvalitete skrbi. Ispitanici i metode: Opservacijsko istraživanje provedeno je 2017. godine u devet specijalističkih ordinacija obiteljske medicine diljem Hrvatske, a uključivalo je 169 bolesnika koji su ili preboljeli infarkt miokarda i/ili su bili podvrgnuti perkutanoj koronarnoj intervenciji i/ili operaciji aortokoronarnog premoštenja. Praćene su vrijednosti krvnog tlaka, LDL kolesterola i indeksa tjelesne mase, a ispitivano je pridržavanje poželjnih oblika ponašanja (nepušenje, tjelesna aktivnost, pravilna prehrana, redovno uzimanje dokazano djelotvornih lijekova) te prilagodba novom stilu života koja je mjerena Likertovom ljestvicom (1-5) kao i zadovoljstvo liječnika preglednošću elektroničkog zdravstvenog zapisa. Rezultati: Zadovoljavajuće vrijednosti arterijskog tlaka postignute su u 63,2 % ispitanika, razinu LDL kolesterola prema smjernicama imalo je 19,4 %, dok je 25,3 % ispitanika imalo uredan indeks tjelesne mase; 25,1 % ispitanika je i dalje pušilo, dok je 43,2 % ispitanika konzumiralo alkohol. Prehrambene navike promijenilo je 63,7 % ispitanika, a 63,4 % je povećalo svoju tjelesnu aktivnost. LOM je u većini slučajeva proveo savjetovanje oko promjene životnog stila nakon koronarnog incidenta. Liječnici su većinom bili zadovoljni sadržajem i količinom podataka u elektroničkom zdravstvenom zapisu, ali ne i njihove upotrebljivosti u svakodnevnoj, vremenski ograničenoj konzultaciji s bolesnikom. Osmišljeno rješenje u programu Adobe Illustrator® omogućilo bi i olakšalo bolju preglednost rizičnih čimbenika i time bi moglo imati utjecaja na učinkovitiju kontrolu provođenja mjera sekundarne prevencije. Zaključak: Skrb za bolesnike s koronarnom bolešću u obiteljskoj medicini je vrlo kompleksna, a dio kompleksnosti se odnosi na primjenu mjera sekundarne prevencije koje su od vitalne važnosti. Zbog toga je potrebno planirati i osigurati dovoljno vremena za konzultaciju s takvim bolesnicima kako bi se dobio uvid u kontrolu rizičnih čimbenika i pravovremeno učinile promjene sukladno važećim smjernicama. Rezultati istraživanja pokazali su da se u bolesnika svi rizični čimbenici ne nalaze unutar preporučenih vrijednosti te da je jedan od mogućih razloga tome što ne postoji njihov pregledan prikaz u elektroničkom zdravstvenom zapisu. Kvalitetnija skrb mogla bi se postići kada bi postojalo jasno vizualno rješenje stanja rizičnih čimbenika koje je u ovom radu osmišljeno i predloženo u obliku slika koje bi LOM-u dale brzi uvid u “profi l” bolesnika te poboljšale učinkovitost svake konzultacije s obzirom na njeno kratko vremensko ograničenje u svakodnevnim uvjetima rada u ordinacijama obiteljske medicine.Introduction: Patients with coronary artery disease represent a challenge in each family medicine practice because of many comorbidities and the application of secondary prevention measures which represent a tool for tracking and simultaneously correcting risk factors related to the patient, his surroundings and lifestyle. Objective: Explore the effectiveness of family medicine specialists in applying secondary prevention measures in cardiovascular diseases and to find a solution for improving quality of care. Participants and Methods: This observational study, was conducted in 2017. under nine specialised family medicine practices throughout Croatia and included 169 patients who suffered from myocardial infarction and/or underwent percutaneous coronary intervention and/or bypass surgery. Blood pressure, LDL cholesterol and body mass index were measured and it was examined whether the participants were abiding to the advised healthy habits (nonsmoking, physically active, good diet, regular use of medicaments according to the guidelines). Adjustment to the new lifestyle was measured with Likert scale (1-5) and the same scale was used to asses physicians satisfaction with transparency of electronic health record data. Results: 63.2% of participants had recommended values for blood pressure, 19.4% for LDL cholesterol and 25.3% had a normal body mass index according to the guidelines. 25.1% of participants continued to smoke and 43.2% continued alcohol consumption. In terms of diet, a change was observed in 63.7% and physical activity increase in 63.4% of participants. In most cases, after coronary incident, physician consulted them regarding lifestyle changes. Family medicine specialists were mostly pleased with the content and the amount of data in electronic health records, but not with their transparency and ease of use in everyday, usually time constrained, patient - doctor consultations. A software application Adobe Illustrator® was used to visually represent the relevant risk factors which could provide more effective control for conducting secondary prevention measures. Conclusion: The care for coronary artery disease patients in family medicine is very complex, and a part of it is related to providing effective measures of secondary prevention which are of crucial importance. Therefore it is imperative to plan ahead and allow sufficient consultation time to obtain control over the risk factors and make timely changes according to the guidelines. Research results have shown that not all risk factors are within recommended values and one of the reasons could be the lack of clear presentation in the electronic health record. Better quality of care could be achieved with the proposed visual solution using pictures that allows the family physician fast access to the patient’s “profile” and improves efficiency of every consultation despite its constrained duration in everyday conditions

TRANSPORT I PREKRCAJ TERETA KOD RO-RO BRODOVA

Ovaj završni rad obrađuje temu o Ro-Ro brodovima (Roll on-Roll off) te njihovom transportu i prekrcaju. Riječ je o brodovima koji prevoze teret na kotačima npr. automobile, vlakove i vojna vozila uključujući putnike i ostale vrste tereta. Karakteristični su po svom horizontalnom ukrcaju i iskrcaju tereta na kotačima pomoću brodske rampe. U radu su prikazane prednosti i nedostatci Ro-Ro brodova te sredstva i opremu koju koriste za što učinkovitiji ukrcaj i iskrcaj tereta. Spominje se njihova povijest, razlog nastanka te sami razvoj koji postiže sve veću i veću razinu. Dotaknut ću se i Ro-Ro terminala, nabrojati vrste, njihovu zadaću te prikazati raspored istih.This final paper explains Ro-Ro ships (Roll on-Roll off) as the main subject and about its transport and transhipment from ship to ship. It is about ships which transport rolling load for example cars, trains, military vehicles including passengers and other sorts of a load. They are characterized by their horizontal loading and unloading of rolling cargo by a ship's ramp. This paper presents the advantages and disadvantages of Ro-Ro ships as well as the means and equipment they use for the most efficient loading and unloading of cargo. It also mentions their history, the reason for their origin and the development itself, which is reaching a higher and higher level. I will also mention Ro-Ro terminals, their types, tasks and show the schedule of the same

INCOME FROM EMPLOYMENT WITH REFERENCE TO THE ANNUAL SALARY CALCULATION

Ovaj rad obrađuje temu dohotka od nesamostalnog rada sa osvrtom na godišnji obračun plaće. Svaki radnik koji obavlja rad za poslodavca ostvaruje pravo na naknadu za svoj rad i druga prava koja proizlaze iz takvog odnosa. Dohodak od nesamostalnog rada definiramo kao razliku između primitaka u novcu ili u naravi i izdat aka poput doprinosa za obvezna osiguranja, a odnose se na porezno razdoblje (kalendarsku godinu) u kojoj je primitak ostvaren. Završetkom poreznog razdoblja poslodavac ima obavezu izvršiti godišnji obračun plaće kako bi se utvrdilo da li je ispravno uplaćivan porez i prirez na dohodak koji je ostvaren tijekom tog razdoblja. Kroz ovaj završni rad biti će objašnjeni osnovni pojmovi o porezu na dohodak i dohodak od nesamostalnog rada, način obračuna i prijave plaće putem JOPPD obrasca te način na koji se provodi godišnji obračun plaće.This paper deals with the topic of income from employment with reference to the annual salary calculation. Every employee who performs work for an employer has the right to compensation for his work and other rights arising from such employment. We define income as the difference between earnings in money or goods and expenses such as mandatory insurance, which refer to the tax period (calendar year) in which the income was made. At the end of the tax period, the employer has the obligation to perform an annual salary calculation in order to determine whether the tax and surcharge on the income earned during that period were correctly paid. This paper will explain the basic concepts of income tax and income from employment, the method of calculation and reporting of salary using the JOPPD form, and the way in which the annual salary calculation is carried out

INCOME FROM EMPLOYMENT WITH REFERENCE TO THE ANNUAL SALARY CALCULATION

Ovaj rad obrađuje temu dohotka od nesamostalnog rada sa osvrtom na godišnji obračun plaće. Svaki radnik koji obavlja rad za poslodavca ostvaruje pravo na naknadu za svoj rad i druga prava koja proizlaze iz takvog odnosa. Dohodak od nesamostalnog rada definiramo kao razliku između primitaka u novcu ili u naravi i izdat aka poput doprinosa za obvezna osiguranja, a odnose se na porezno razdoblje (kalendarsku godinu) u kojoj je primitak ostvaren. Završetkom poreznog razdoblja poslodavac ima obavezu izvršiti godišnji obračun plaće kako bi se utvrdilo da li je ispravno uplaćivan porez i prirez na dohodak koji je ostvaren tijekom tog razdoblja. Kroz ovaj završni rad biti će objašnjeni osnovni pojmovi o porezu na dohodak i dohodak od nesamostalnog rada, način obračuna i prijave plaće putem JOPPD obrasca te način na koji se provodi godišnji obračun plaće.This paper deals with the topic of income from employment with reference to the annual salary calculation. Every employee who performs work for an employer has the right to compensation for his work and other rights arising from such employment. We define income as the difference between earnings in money or goods and expenses such as mandatory insurance, which refer to the tax period (calendar year) in which the income was made. At the end of the tax period, the employer has the obligation to perform an annual salary calculation in order to determine whether the tax and surcharge on the income earned during that period were correctly paid. This paper will explain the basic concepts of income tax and income from employment, the method of calculation and reporting of salary using the JOPPD form, and the way in which the annual salary calculation is carried out

INCOME FROM EMPLOYMENT WITH REFERENCE TO THE ANNUAL SALARY CALCULATION

Ovaj rad obrađuje temu dohotka od nesamostalnog rada sa osvrtom na godišnji obračun plaće. Svaki radnik koji obavlja rad za poslodavca ostvaruje pravo na naknadu za svoj rad i druga prava koja proizlaze iz takvog odnosa. Dohodak od nesamostalnog rada definiramo kao razliku između primitaka u novcu ili u naravi i izdat aka poput doprinosa za obvezna osiguranja, a odnose se na porezno razdoblje (kalendarsku godinu) u kojoj je primitak ostvaren. Završetkom poreznog razdoblja poslodavac ima obavezu izvršiti godišnji obračun plaće kako bi se utvrdilo da li je ispravno uplaćivan porez i prirez na dohodak koji je ostvaren tijekom tog razdoblja. Kroz ovaj završni rad biti će objašnjeni osnovni pojmovi o porezu na dohodak i dohodak od nesamostalnog rada, način obračuna i prijave plaće putem JOPPD obrasca te način na koji se provodi godišnji obračun plaće.This paper deals with the topic of income from employment with reference to the annual salary calculation. Every employee who performs work for an employer has the right to compensation for his work and other rights arising from such employment. We define income as the difference between earnings in money or goods and expenses such as mandatory insurance, which refer to the tax period (calendar year) in which the income was made. At the end of the tax period, the employer has the obligation to perform an annual salary calculation in order to determine whether the tax and surcharge on the income earned during that period were correctly paid. This paper will explain the basic concepts of income tax and income from employment, the method of calculation and reporting of salary using the JOPPD form, and the way in which the annual salary calculation is carried out

CARE QUALITY FOR PATIENTS WITH CORONARY ARTERY DISEASE IN FAMILY MEDICINE - GUIDELINE IMPLEMENTATION BY TAKING A GLANCE AT THE RISK FACTORS

Uvod: Bolesnici s koronarnom bolešću su velik izazov u skrbi liječnika obiteljske medicine (LOM) zbog brojnih komorbiditeta te primjene mjera sekundarne prevencije kojima se prate i istovremeno korigiraju rizični čimbenici koji se odnose na bolesnika, njegovu okolinu i stil života. Cilj: Istražiti uspješnost LOM-a u primjeni mjera sekundarne prevencije kardiovaskularnih bolesti i pronaći moguće rješenje za poboljšanje kvalitete skrbi. Ispitanici i metode: Opservacijsko istraživanje provedeno je 2017. godine u devet specijalističkih ordinacija obiteljske medicine diljem Hrvatske, a uključivalo je 169 bolesnika koji su ili preboljeli infarkt miokarda i/ili su bili podvrgnuti perkutanoj koronarnoj intervenciji i/ili operaciji aortokoronarnog premoštenja. Praćene su vrijednosti krvnog tlaka, LDL kolesterola i indeksa tjelesne mase, a ispitivano je pridržavanje poželjnih oblika ponašanja (nepušenje, tjelesna aktivnost, pravilna prehrana, redovno uzimanje dokazano djelotvornih lijekova) te prilagodba novom stilu života koja je mjerena Likertovom ljestvicom (1-5) kao i zadovoljstvo liječnika preglednošću elektroničkog zdravstvenog zapisa. Rezultati: Zadovoljavajuće vrijednosti arterijskog tlaka postignute su u 63,2 % ispitanika, razinu LDL kolesterola prema smjernicama imalo je 19,4 %, dok je 25,3 % ispitanika imalo uredan indeks tjelesne mase; 25,1 % ispitanika je i dalje pušilo, dok je 43,2 % ispitanika konzumiralo alkohol. Prehrambene navike promijenilo je 63,7 % ispitanika, a 63,4 % je povećalo svoju tjelesnu aktivnost. LOM je u većini slučajeva proveo savjetovanje oko promjene životnog stila nakon koronarnog incidenta. Liječnici su većinom bili zadovoljni sadržajem i količinom podataka u elektroničkom zdravstvenom zapisu, ali ne i njihove upotrebljivosti u svakodnevnoj, vremenski ograničenoj konzultaciji s bolesnikom. Osmišljeno rješenje u programu Adobe Illustrator® omogućilo bi i olakšalo bolju preglednost rizičnih čimbenika i time bi moglo imati utjecaja na učinkovitiju kontrolu provođenja mjera sekundarne prevencije. Zaključak: Skrb za bolesnike s koronarnom bolešću u obiteljskoj medicini je vrlo kompleksna, a dio kompleksnosti se odnosi na primjenu mjera sekundarne prevencije koje su od vitalne važnosti. Zbog toga je potrebno planirati i osigurati dovoljno vremena za konzultaciju s takvim bolesnicima kako bi se dobio uvid u kontrolu rizičnih čimbenika i pravovremeno učinile promjene sukladno važećim smjernicama. Rezultati istraživanja pokazali su da se u bolesnika svi rizični čimbenici ne nalaze unutar preporučenih vrijednosti te da je jedan od mogućih razloga tome što ne postoji njihov pregledan prikaz u elektroničkom zdravstvenom zapisu. Kvalitetnija skrb mogla bi se postići kada bi postojalo jasno vizualno rješenje stanja rizičnih čimbenika koje je u ovom radu osmišljeno i predloženo u obliku slika koje bi LOM-u dale brzi uvid u “profi l” bolesnika te poboljšale učinkovitost svake konzultacije s obzirom na njeno kratko vremensko ograničenje u svakodnevnim uvjetima rada u ordinacijama obiteljske medicine.Introduction: Patients with coronary artery disease represent a challenge in each family medicine practice because of many comorbidities and the application of secondary prevention measures which represent a tool for tracking and simultaneously correcting risk factors related to the patient, his surroundings and lifestyle. Objective: Explore the effectiveness of family medicine specialists in applying secondary prevention measures in cardiovascular diseases and to find a solution for improving quality of care. Participants and Methods: This observational study, was conducted in 2017. under nine specialised family medicine practices throughout Croatia and included 169 patients who suffered from myocardial infarction and/or underwent percutaneous coronary intervention and/or bypass surgery. Blood pressure, LDL cholesterol and body mass index were measured and it was examined whether the participants were abiding to the advised healthy habits (nonsmoking, physically active, good diet, regular use of medicaments according to the guidelines). Adjustment to the new lifestyle was measured with Likert scale (1-5) and the same scale was used to asses physicians satisfaction with transparency of electronic health record data. Results: 63.2% of participants had recommended values for blood pressure, 19.4% for LDL cholesterol and 25.3% had a normal body mass index according to the guidelines. 25.1% of participants continued to smoke and 43.2% continued alcohol consumption. In terms of diet, a change was observed in 63.7% and physical activity increase in 63.4% of participants. In most cases, after coronary incident, physician consulted them regarding lifestyle changes. Family medicine specialists were mostly pleased with the content and the amount of data in electronic health records, but not with their transparency and ease of use in everyday, usually time constrained, patient - doctor consultations. A software application Adobe Illustrator® was used to visually represent the relevant risk factors which could provide more effective control for conducting secondary prevention measures. Conclusion: The care for coronary artery disease patients in family medicine is very complex, and a part of it is related to providing effective measures of secondary prevention which are of crucial importance. Therefore it is imperative to plan ahead and allow sufficient consultation time to obtain control over the risk factors and make timely changes according to the guidelines. Research results have shown that not all risk factors are within recommended values and one of the reasons could be the lack of clear presentation in the electronic health record. Better quality of care could be achieved with the proposed visual solution using pictures that allows the family physician fast access to the patient’s “profile” and improves efficiency of every consultation despite its constrained duration in everyday conditions