MONTESORI METODA – OSNOVA INTEGRISANOG UČENJA MATEMATIKE

This research offers a theoretical comparative analysis of the Montessori Method and integrative teaching. Current trends call for incorporation of an integrative approach into educational practice. From the constructivists’ cognitive perspective knowledge is constantly changing, and results from acting and thinking. Maria Montessori developed an approach which is intellectually challenging and motivating. It develops a creative, flexible, authentic and constructive personality. In this paper we focus on theoretical aspects of both Montessori Method and integrative approach and look for compatible elements. We pay special attention to effects of the Montessori Method on development of mathematical aspects of reasoning. Our argument is that preschool Montessori Method has the capacity to become the basis for an integrative school approach. This provides a smooth move from early childhood learning to school learning. We point to the similarity of learning goals. Also, we pay attention to features of productive environments created within these two Methods for mathematics learning. In the light of the analysis, we suggest common features of the Montessori Method and integrated curriculum approach which have positive effects on mathematics learning. Finally, we draw some educational and curricular research questions. Our argument is that the Montessori Method presents natural prerequisites for integrated learning. We conclude that together they fulfil the social need for functional knowledge and holistic approach to a child’s development.Rad nudi teorijsku komparativnu analizu Montesori metode i integrativne nastave. Savremene tendencije ukazuju na potrebu uključivanja integrativnog pristupa u obrazovnu praksu. Sa stanovišta konstruktivizma znanje se neprestano menja i rezultat je akcije i razmišljanja. Marija Montesori je razvila metod koji je intelektualno provokativan i motivišući. Njime se razvija kreativna, fleksibilna, autentična i konstruktivna ličnost. U ovom radu, mi smo se fokusirali na teorijske aspekte obe metode: Montesori metode i integrativne metode tražeći kompatibilne elemente. Posebnu pažnju posvetili smo efektima Montesori metode na razvoj matematičkog mišljenja. Mi pružamo argumentaciju u prilog teze da predškolski Montesori pristup ima kapacitet da bude osnova integrativnog učenja u školi. On predstavlja gladak prelazak sa ranog učenja na školsko učenje. Ukazujemo na sličnost ciljeva ucenja. Takodje, posebnu pažnju posvećujemo sredini kreiranoj u ova dva pristupa posebno pogodnoj za učenje matematike. U svetlu date analize, ukazujemo na zajedničke osobenosti Montesori metode i integrativne metode koji imaju pozitivan efekat na učenje. Konačno, mi ukazujemo na neka obrazovna i kurikularna istraživačka pitanja. Naš stav je da Montesori metoda predstavlja prirodnu osnovu za integrativo učenje. Zaključujemo da zajedno one mogu ispuniti potrebu društva za funkcionalnim znanjima i holističnim razvojem dece

Analysis of the Professional Aspects of Medical Drugs Industry in the Republic of Serbia in Times of COVID-19 Pandemic

The research subject of this paper is the analysis of the attitudes of employees in pharmaceutical companies towards the business aspects of the pharmaceutical industry during and after the end of the pandemic in the Republic of Serbia. The aim is to examine the differences in the attitudes of employees, as well as to determine which variables predict the situations of endangering the professional reputation of pharmaceutical companies during the COVID-19 pandemic. The research was conducted by means of a survey during 2021 on a sample of 27 innovative and generic pharmaceutical companies. We used the SPSS program for descriptive statistics analysis, chi square test and binary logistic regression models. The findings show that there is a statistically significant difference in the expressed attitudes of employees in innovative and generic pharmaceutical companies in terms of coming to the office during the pandemic; the lack of medicines and medical devices used in the treatment of COVID-19 infections; the patient access to a chosen doctor; the expectations of the employees to continue working from home after the outbreak of the COVID-19 pandemic. The findings of the binary regression models show the slowdown in the supply chain, the access to doctors and working from the home office have not been perceived as creating situations of endangering professional reputations, that is, they contribute to the sustainable economic success. On the other hand, the introduction of digital technologies decreases the occurrence of conditions in which their professional reputation has been threatened

Predictors of Inadequate Health Literacy among Patients with Type 2 Diabetes Mellitus: Assessment with Different Self-Reported Instruments

INTRODUCTION: Obtaining, understanding, interpreting, and acting on health information enables people with diabetes to engage and make health decisions in various contexts. Hence, inadequate health literacy (HL) could pose a problem in making self-care decisions and in self-management for diabetes. By applying multidimensional instruments to assess HL, it is possible to differentiate domains of functional, communicative, and critical HL. OBJECTIVES: Primarily, this study aimed to measure the prevalence of inadequate HL among type 2 diabetes mellitus patients and to analyze the predictors influencing health literacy levels. Secondly, we analyzed if different self-reported measures, unidimensional instruments (Brief Health Literacy instruments (BRIEF-4 and abbreviated version BRIEF-3), and multidimensional instruments (Functional, Communicative and Critical health literacy instrument (FCCHL)) have the same findings. METHODS: The cross-sectional study was conducted within one primary care institution in Serbia between March and September 2021. Data were collected through Serbian versions of BRIEF-4, BRIEF-3, and FCCHL-SR12. A chi-square test, Fisher's exact test, and simple logistic regression were used to measure the association between the associated factors and health literacy level. Multivariate analyses were performed with significant predictors from univariate analyses. RESULTS: Overall, 350 patients participated in the study. They were primarily males (55.4%) and had a mean age of 61.5 years (SD = 10.5), ranging from 31 to 82 years. The prevalence of inadequate HL was estimated to be 42.2% (FCCHL-SR12), 36.9% (BRIEF-3) and 33.8% (BRIEF-4). There are variations in the assessment of marginal and adequate HL by different instruments. The highest association was shown between BRIEF-3 and total FCCHL-SR12 score (0.204, p < 0.01). The total FCCHL-SR12 score correlates better with the abbreviated BRIEF instrument (BRIEF-3) than with BRIEF-4 (0.190, p < 0.01). All instruments indicated the highest levels for the communicative HL domain and the lowest for the functional HL domain with significant difference in functional HL between the functional HL of FCCHL-SR12 and both BRIEF-3 and BRIEF-4 (p = 0.006 and 0.008, respectively). Depending on applied instruments, we identified several variables (sociodemographic, access to health-related information, empowerment-related indicators, type of therapy, and frequency of drug administration) that could significantly predict inadequate HL. Probability of inadequate HL increased with older age, fewer children, lower education level, and higher consumption of alcohol. Only high education was associated with a lower probability of inadequate HL for all three instruments. CONCLUSIONS: The results we obtained indicate that patients in our study may have been more functionally illiterate, but differences between functional level could be observed if assessed by unidimensional and multidimensional instruments. The proportion of patients with inadequate HL is approximately similar as assessed by all three instruments. According to the association between HL and educational level in DMT2 patients we should investigate methods of further improvement

Farmakoekonomska evaluacija fakoemulzifikacije i ekstrakapsularne ekstrakcije u operaciji katarakte

Background/Aim. Cataract surgery is one of the most often performed surgical interventions. The predominant method in Western countries is phacoemulsification, while in developing countries, the extracapsular cataract extraction (ECCE) method remains popular. The aim of the study was to evaluate the cost- effectiveness of these two cataract surgery techniques from the provider’s perspective if operation complications were the out- come of the interest. Methods. The data were obtained from the Department of Ophthalmology of the General Hospital Kruševac during a one-year period. A total of 1,179 surgeries by five surgeons were performed. The cost-effectiveness was evaluated using the decision tree. All probabilities were calcu- lated based on the likelihood of the occurrence during the study period. Only direct costs were considered, and values were taken from the documentation at the hospital and the of- ficial price list of health services. One- and two-way sensitivity analyses were performed. Results. The total cost per patient in the phacoemulsification group was 71,008.70 Serbian dinars (RSD), while the total cost in the ECCE group was 74,340.36 RSD. At the same time, phacoemulsification shows higher ef- fectiveness than the ECCE method, with 87% and 57% of pa- tients without complications, respectively. With these results, phacoemulsification was the dominant strategy compared to ECCE. The sensitivity analysis revealed that the results are sen- sitive to the number of performed operations per year. Con- clusion. The phacoemulsification technique seems to be the preferred technique for cataract surgery. All the investment in phacoemulsification equipment and consumables is justified if the number of surgeries per year exceeds 350.Uvod/Cilj. Operacija katarakte predstavlja jednu od najčešće primenjivanih hirurških intervencija. U zapadnim zemljama, dominantna tehnika je fakoemulzifikacija, dok je u zemljama u razvoju najzastupljenija tehnika ekstrakapsularne ekstrakcije (ECCE). Cilj rada bio je da se proceni ekonomska isplativost te dve tehnike operacije katarakte iz perspektive pružaoca usluge, ukoliko se kao ishod posmatraju komplikacije. Metode. Podaci su dobijeni sa Očnog odeljenja Opšte bolnice Kruševac tokom jednogodišnjeg perioda. Ukupno je izvedeno 1 179 operacija od strane pet hirurga. Ekonomska isplativost je procenjena primenom „drveta odlučivanja“. Verovatnoće za događaje su izračunate na osnovu verovatnoće pojavljivanja tokom navedenog perioda. U analizi su razmatrani samo direktni troškovi, a vrednosti su preuzete iz prateće dokumentacije i zvaničnog cenovnika zdravstvenih usluga. Sprovedena je jednosmerna i dvosmerna analiza osetljivosti. Rezultati.Ukupni troškovi u grupi koja je bila podvrgnuta fakoemulzifikaciji iznosili su 71 008.70 srpskih dinara (RSD), dok su u ECC E grupi oni iznosili 74 340.36 RSD. Istovremeno, fakoemulzifikacija je pokazala višu efikasnost u odnosu na ECCE, 87% i 57% bolesnika bez komplikacija, redom. Na osnovu dobijenih rezultata, fakoemulzifikacija je bila dominantna strategija u poređenju sa ECCE. Analiza osetljivosti pokazala je da su rezultati osetljivi na broj izvršenih intervencija na godišnjem nivou. Zaključak. Fakoemulzifikacija je ekonomski isplativija tehnika operacije katarakte u odnosu na ECCE. Sva ulaganje u opremu i potrošni materijal za fakoemulzifikaciju opravdani su ukoliko je broj izvedenih operacija na godišnjem nivou preko 350

THE RELATIONSHIP BETWEEN TECHNICAL AND TACTICAL ELEMENTS OF DIRECT POINTS WITH REGARD TO THE QUALIFICATIONS FOR THE 2018 VOLLEYBALL WOMEN’S WORLD CHAMPIONSHIP

The goal of this paper is to analyse the relationships and differences among volleyball teams, participants of the 2018 World Cup in Japan, divided into three categories by their final standings (1st to 4th place, 5th to 8th place and others), based on the elements of situation-based efficiency. For the purposes of this paper, information from the official match reports (p 2 report) related to the way of winning points in the match was used, and these data were analysed using the program Volleyball Information System (VIS). The data obtained were analysed in relation to the team category and the outcome of the match. The data were obtained using descriptive and comparative statistical procedures. The survey sample includes all the women’s volleyball championship games played in Japan in 2018. Based on the final standings, the teams were divided into three groups: 1) the teams who reached the 3rd stage of the tournament (6 teams, from 1st to 6th place); 2) the teams that finished the competition in phase 2 (10 national teams, ranking 7th to 16th); 3) national teams that finished the competition in phase 1 (8 national teams, ranking 17th to 24th). The results obtained indicate that the teams had an equally good performance of the block and serve game elements; statistically these were not significant for the match outcome, but they rather serve as an aid for the overall game and for the final outcome of the match. The results of this research also highlight the spike as the key element affecting the positive end result of the match. It is important to emphasize that the opponent errors are a factor that depends exclusively on the opponent, but they also determine the overall score of the winning team

Economic evaluation of different screening alternatives for patients with clinically suspected acute deep vein thrombosis

Introduction: We examined the cost-effectiveness of the three different D-dimer measurements in the screening of DVT in models with and without calculation of pre-test probability (PTP) score. Moreover, we calculated the minimal cost in DVT detection. Material and methods: In the group of 192 patients with clinically suspected acute DVT, we examined the three different D-dimer measurements (Innovance D-dimer, Hemosil D-dimer HS and Vidas D-dimer Exclusion II) in combination with and without PTP assessment. Results: The diagnostic alternative employing Vidas D-dimer Exclusion II assay without and with PTP calculation gave lower incremental cost-effectiveness ratio (ICER) than the alternative employing Hemosil D-dimer HS assay (0.187 Euros vs. 0.998 Euros per one additional DVT positive patient selected for CUS in model without PTP assessment and 0.450 vs. 0.753 Euros per one DVT positive patient selected for CUS in model with PTP assessment). According to sensitivity analysis, the Hemosil D-dimer HS assay was the most cost effective alternative when one patient was admitted to the vascular ambulance per day. Vidas D-dimer Exclusion II assay was the most cost effective alternative when more than one patient were admitted to the vascular ambulance per day. Cost minimisation analysis indicated that selection of patients according to PTP score followed by D-dimer analysis decreases the cost of DVT diagnosis. Conclusions: ICER analysis enables laboratories to choose optimal laboratory tests according to number of patients admitted to laboratory. Results support the feasibility of using PTP scoring and D-dimer measurement before CUS examination in DVT screening

Farmakoekonomska evaluacija pružanja farmaceutske usluge pacijentima na antikoagulantnoj terapiji varfarinom

It has been determined that Pharmacist-Managed Anticoagulation Service (PMAS) for patients on warfarin improves anticoagulation control and decreases the rate of bleeding, thus reducing the overall health care costs. This study aims to compare the cost-effectiveness of providing pharmaceutical care (PC) and usual medical care (UMC) to patients on warfarin, from the perspective of the National Health Insurance Fund (NHIF) in Serbia. The cost-effectiveness analysis was conducted, with a time horizon of 10 days. Decision tree modeling combined data on efficacy from eligible studies, while the costs were taken from NHIF Drug and Service fee lists. Additionally, the budget impact analysis was performed, aiming to project annual savings by implementing PMAS as a part of anticoagulation clinics. PC has been perceived to be cost-effective strategy, since it enables a higher probability of well controlled INR value (additional effectiveness 0,154), along with lower costs (-374,51 RSD), compared to UMC. Negative incremental cost-effectiveness ratio additionally demonstrated cost-effectiveness of PC, as dominant strategy. Sensitivity analysis confirmed the model robustness, and budget impact analysis has also demonstrated significant annual savings, in the total amount of 50.863.313 RSD for a five year period 2016-2020. Providing PC to patients on warfarin represents a more cost-efficient strategy than UMS, in addition to better safety profile, which is why it should be implemented in the national health care system in the future.Utvrđeno je da sprovođenje menadžmenta terapije varfarinom od strane farmaceuta značajno unapređuje kontrolu antikoagulacije i smanjuje broj slučajeva krvarenja, a time i pridružene troškove lečenja. Cilj ovog rada je farmakoekonomska evaluacija pružanja farmaceutske zdravstvene zaštite (FZZ) pacijentima na varfarinu u odnosu na standardnu zdravstvenu zaštitu (SZZ), iz perspektive Republičkog fonda za zdravstveno osiguranje (RFZO). Sprovedena je analiza isplativosti primenom drveta odlučivanja, za period od 10 dana. U modelu su kombinovani podaci za posmatrane ishode iz odgovarajućih studija, dok su direktni medicinski troškovi preuzeti iz važećih cenovnika zdravstvenih usluga, kao i Liste lekova RFZO. Dodatno je sprovedena analiza uticaja na budžet, radi projektovanja potencijalnih ušteda u slučaju implementacije ove farmaceutske usluge. FZZ je troškovno isplativija strategija, obzirom na veću efektivnost (+0,154), a manji trošak (-374,51 RSD) u odnosu na SZZ. Negativna vrednost inkrementalnog odnosa troškova i efektivnosti za FZZ dodatno potvrđuje njenu isplativost, kao dominantne strategije. Analiza osetljivosti je potvrdila robusnost modela, dok su analizom uticaja na budžet projektovane značajne uštede, od 50.863.313 RSD za petogodišnji period 2016.-2020. Pružanje FZZ pacijentima na antikoagulantnoj terapiji varfarinom predstavlja troškovno-isplativiju strategiju u odnosu na SZZ u Republici Srbiji, zbog čega je poželjno da se implementira u nacionalni zdravstveni sistem u budućnosti

Impact of discounting in pharmacoeconomic modeling. A case study

Discounting adjusts future costs and benefits in terms of their present value. The purpose of this study was to present the effect of discounting on Markov model prepared for the evaluation of the different antihypertensive treatments in Serbia. The Markov model consisting of eight states with the cycle length of six months was constructed. Comparator strategies were diuretic, beta blocker; calcium channel blocker and ACE inhibitors. All therapeutic strategies were compared with strategy no intervention". Complications of hypertension (acute myocardial infraction, angina pectoris or stroke alone or in combinations) and total mortality were observed as outcomes. Time horizon of the study was lifetime of the patient or 100 years old, due to assumption that 99% of the cohort would die at that age. Analyses were performed from the third-party payer perspective. Annual discount rate of 5% was applied at all future costs and effects. Undiscounted results showed that patients who started treatment with a beta blocker had the highest life expectancy (49.00 QALY) and being the most cost-effective strategy (ICER = (sic)46.63/QALY compared to no intervention). In the case of discounting the highest gain in the QALY had patients who were on beta blocker, 23.7 QALY. After the discounting cost-effective strategies were ACE inhibitor (ICER = (sic)253.08/QALY compared to no intervention) and diuretic (ICER = (sic)262.54/QALY compared to no intervention). The results of the study showed that the discounting could change the choice of cost-effective therapeutic strategy Biotechnol. & Biotechnol. Eq. 2011, 25(3), 2555-255

Farmakoekonomska evaluacija primene rastvora za infuziju kaspofungina i amfotericina B u terapiji teških sistemskih mikoza

Empirical application of antifungal drugs in the treatment of invasive fungal infections (IFI) in febrile neutropenia represent significant cost, but it is essential in patients with leukemia and after hematopoietic stem cell transplantation. Numerous clinical studies have shown little difference in the efficacy of amphotericin B and caspofungin in IFI empirical therapy, but it does not reflect their cost-effectiveness. The aim of this study was to compare the costeffectiveness of caspofungin and amphotericin B lipid complex (ABLC) in the empirical antifungal therapy in patients with febrile neutropenia using model-decision tree, from the perspective of the National Health Insurance Fund (NHIF). We used the cost-effectiveness analysis, for a period of 14 days of therapy. In model we combined data on efficacy from randomized clinical trials, while the costs were taken from the Drug list or service fee NHIF. The total cost per additional cured fungal infection with caspofungin was 639,750.06 RSD, while with ABLC was 2,153,403.61 RSD. In the sensitivity analysis, using different weights of patients (50kg or 70kg) and different doses of ABLC, caspofungin was again most cost-effective strategy for empirical antifungal therapy. Caspofungin, in addition to a better safety profile, is more cost-efficient than ABLC. This fact should be kept in mind when choosing a therapy for the treatment of IFI in patients with febrile neutropenia.Empirijska primena antimikotika u terapiji invazivnih gljivičnih infekcija (IGI) u febrilnoj neutropeniji predstavlja značajan trošak, ali je neophodna kod pacijenata sa leukemijom i nakon transplantacije matičnih ćelija hematopoeze. Brojne kliničke studije pokazale su male razlike u efikasnosti amfotericina B i kaspofungina u empirijskoj terapiji IGI, ali to ne oslikava u pravoj meri odnos trošak-efektivnost. Cilj rada je bio poređenje isplativosti kaspofungina i amfotericina B lipidni kompleks (ABLC) u empirijskoj antigljivičnoj terapiji kod pacijenata sa febrilnom neutropenijom kroz model-drvo odlučivanja, a iz perspektive Republičkog fonda za zdravstveno osiguranje (RFZO). Primenjena je analiza isplativosti, (cost-effectiveness analsys - CEA), za period od 14 dana terapije. U modelu su kombinovani podaci o efikasnosti iz randomizovanih kliničkih studija, dok su troškovi uzeti iz važećeg cenovnika zdravstvenih usluga i Liste lekova RFZO. Ukupan trošak po dodatno izlečenoj gljivičnoj infekciji za kaspofungin iznosi 639.750,06 RSD, dok je za ABLC 2.153.403,61 RSD. U analizi osetljivosti, primenom različite telesne težine pacijenata (50kg ili 70kg) i različite doze ABLC, kaspofungin je ponovo bio isplativija strategija empirijske antigljivične terapije. Kaspofungin, pored boljeg bezbednosnog profila je i troškovno isplativiji od ABLC. Ovu činjenicu bi trebalo imati u vidu prilikom odabira terapije za lečenje IGI kod pacijenata sa febrilnom neutropenijom

The cost-effectiveness of hypertension pharmacotherapy in Serbia: A Markov model

To date there is no Markov model to evaluate the cost-effectiveness of antihypertensive pharmacotherapies at national level in developing countries. The aim of our study was to evaluate different antihypertensives and determine their cost-effectiveness as mono therapy treatment in primary care in Serbia. We developed a Markov model to estimate quality-adjusted life years (QALY), lifetime costs and incremental cost-effectiveness of different antihypertensive medicines used in the clinical practice in Serbia (diuretic, beta blocker Ca channel blocker and ACE inhibitors) to strategy "no intervention". Cohort of 55-year-old patients with hypertension (systolic and diastolic blood pressure >= 140 and 90 mmHg), without cardiovascular complications was run through the model. Acute myocardial infarction, angina pectoris, heart failure, stroke, and total mortality were observed as outcomes. The time horizon was over a lifetime, and the perspective was that of a third-party payer Annual discount rate of 5% was applied to all future costs and effects. The results showed small differences in QALY in strategies ACE inhibitor, beta blockers, and diuretic. The incremental cost-effectiveness ratio (ICER) for diuretic, compared to no intervention, was (sic)74.27/QALY. The ICER for beta blocker compared to diuretic was (sic)75.58/QALY. ACE inhibitor was extended dominated by diuretic and beta blocker, while Ca channel blocker had higher costs and less effectiveness compared to all previous strategies. The results of the probabilistic sensitivity analysis showed that application of antihypertensive therapy is cost-effective even at small values of willingness to pay. It could be concluded that for individuals aged 55 the diuretics are the most cost-effective strategy to start monotherapy of hypertension