Chronic patients: persons with diabetes frequent attenders in Croatian family practice

Chronic diseases cause high frequency visits and generate the long-term frequent attenders (FAs). The connection between frequent attendance and specific morbidities in the health care systems in transitional Europe has been underestimated. We investigated whether frequent visits of chronic patients in primary care are related to characteristic of chronic disease (diabetes mellitus) and whether this is influenced by the family practice in the transitional health care. We analyzed the number of visits a day time work for 490 persons with diabetes in the period 1997 to 2000. As the cut-off points between frequent attenders and non frequent attenders (NFAs) we used the value of the third quartile (Q3) of visits determined for the sex and age groups in the parallel study in the whole population. The analysis was performed for 23 variables: demographic characteristics of patients, disease characteristic and variables of physician. Logistic regressions were employed to identify the predictors of FAs/NFAs. 56.9% (in 1997) to 62.4% (in 2000) persons with diabetes were FAs, compared to 22.4% to 24.3% FAs patients in the whole population. Logistic regression analysis significantly differentiated the two group of visits with 68% accuracy. 4 variables are significant predictors for FAs/NFAs: diabetes as the main disease (p = 0.0005), diet-only-treatment (p = 0.0062), treatment by secondary care (p = 0.0116), and if glycated hemoglobin test (HbA1c) is determined (p = 0.0272). Understanding the similarities and differences of FAs/NFAs persons with diabetes may be important in improving the care and management of chronic diseases in family medicine in transitional health care systems

Antibiotic Prescription Rate for Upper Respiratory Tract Infections and Risks for Unnecessary Prescription in Croatia

Overprescribing of antibiotics in primary care has been recognized as public health problem. We investigated visits prescription rate of antibiotics to patients with upper respiratory tract infections (URTI) and unnecessary prescribtion for tonsillopharyngitis, in Croatia. In prospective observational study in November 2007. 25 GPs in Croatia recorded all patients’ visits with URTI episode according ICPC-2. Clinical status of patients with tonsillopharyngitis were categorized according to Centor Criteria. 689 visits were analysed, 82% of visits were initial. Antibiotics were prescribed in 44.7% visits with URTI. There were no significant differences in antibiotic prescription rates regarding non–clinical factors. Antibiotics were prescribed to patients with tonsillopharyngitis in 62.2% visits. Unnecessary antibiotics were prescribed (Centor 1,2) in 49.6% visits with tonsillopharyngitis. Logistic regression analysis showed significant differences in unnecessary antibiotic prescription rates only with respect to the workday – Wednesday, CI (1.117–2.671), p=0.0139. Leading antibiotic was amoxicillin + clavulonic acid, second was amoxicillin, the third were macrolides, the fourth was narrow spectrum penicillin and fifth were cephalosporins. This study shows over prescription for URTI. Unnecessary prescription for tonsillopharyngitis depend on non clinical factor – day of the week. This should be futher explored and help to improved prescribe antibiotics

Chronic Patients – Persons with Diabetes Frequent Attenders in Croatian Family Practice

Chronic diseases cause high frequency visits and generate the long-term frequent attenders (FAs). The connection between frequent attendance and specific morbidities in the health care systems in transitional Europe has been underestimated. We investigated whether frequent visits of chronic patients in primary care are related to characteristic of chronic disease (diabetes mellitus) and whether this is influenced by the family practice in the transitional health care. We analyzed the number of visits a day time work for 490 persons with diabetes in the period 1997 to 2000. As the cut-off points between frequent attenders and non frequent attenders (NFAs) we used the value of the third quartile (Q3) of visits determined for the sex and age groups in the parallel study in the whole population. The analysis was performed for 23 variables: demographic characteristics of patients, disease characteristic and variables of physician. Logistic regressions were employed to identify the predictors of FAs/NFAs. 56.9% (in 1997) to 62.4% (in 2000) persons with diabetes were FAs, compared to 22.4% to 24.3% FAs patients in the whole population. Logistic regression analysis significantly differentiated the two grup of visits with 68% accuracy. 4 variables are significant predictors for FAs/NFAs: diabetes as the main disease (p=0.0005), diet-only-treatment (p=0.0062), treatment by secondary care (p=0.0116), and if glycated hemoglobin test (HbA1c) is determined (p=0.0272). Understanding the similarities and differences of FAs/NFAs persons with diabetes may be important in improving the care and management of chronic diseases in family medicine in transitional health care systems

Again “On Baroque Neo-Classicism in Pogančec”

Kapelu Majke Božje Lauretanske u Pogančecu, podignutu 1780., istraživala je Anđela Horvat kao primjer baroknog klasicizma. Specifičnim tlocrtno-prostornim rješenjem broda s kupolom na slobodnostojećim stupovima te stupcima u svetištu izdvaja se iz korpusa sakralne arhitekture kontinentalne Hrvatske tog razdoblja i predstavlja sintezu različitih utjecaja. U kupoli se materijalizira marijanska kružnica, stupovi u brodu odjek su baroknog klasicizma, dok su na pročelju, kao i u opremi, prisutni elementi rokokoa.The chapel of Our Lady of Loreto in Pogančec, erected in 1780, was studied by Anđela Horvat as an example of Baroque Neo-Classicism. The specific ground plan and spatial disposition of the nave with dome supported by free-standing columns and pillars in the presbytery distinguish the chapel from other examples of ecclesiastical architecture of inland Croatia, representing a synthesis of diverse influences. The dome materializes the Marian circle, nave columns are a reflection of Baroque Neo-Classicism, while the façade and decorative elements display elements of Rococo

ACCUSTOMING TO HELICOBACTER PYLORI BACTERIUM IN FAMILY PRACTICE

Rezistencija bakterije Helicobacter pylori (HP) na antibiotike danas je globalno rasprostranjen problem. Liječnik obiteljske medicine donosi odluku o liječenju gastrointestinalnih bolesti bez direktnog endoskopskog nalaza i izolata eventualno prisutne bakterije, po principu „testiraj i liječi“. Prije donošenja odluke postavlja pitanja: ima li pacijent infekciju, treba li prisutnost bakterije odrediti, koji dijagnostički test izabrati, treba li propisati antibiotik, koji antibiotik propisati. Prikazane su tri kliničke slike pacijenata koje najčešće susrećemo u praksi: dispepsija, gastroezofagealna refl uksna bolest (GERB), ekstragastrične bolesti koje se vežu uz prisustvo HP. Prikazani su serološki testovi, test antigena HP u stolici i ureja izdisajni test. Zahtjevna je uloga obiteljskog liječnika u istodobnoj racionalizaciji propisivanja antibiotika i eradikaciji HP. Treba stalno imati na umu da je bolest rezultat odgovora nositelja/domaćina i čimbenika–bakterije u varijabli vremena i stupnja oštećenja što je bakterija eventualno izazvala.Today, antibiotic resistance of Helicobacter pylori (HP) is a worldwide problem. The ‘test and treat’ strategy is the recommended approach in family medicine, as family medicine doctors make decisions on treating gastrointestinal conditions without endoscopic fi ndings or HP testing. In treatment strategy, family medicine doctor has to answer several questions: whether the patient has HP infection, is it necessary to evaluate HP infection, which diagnostic test to use in evaluation of HP infection, should he proscribe antibiotic, and which antibiotic to prescribe. In this article, we present three common clinical cases to determine which approach to use in daily practice: dyspepsia, gastroesophageal refl ux disease (GERD), and extragastric diseases associated with HP infection. Serology test, stool antigen test and urea breath test are described. It is required from family medicine doctors not only to rationalize antibiotic prescription but also to eradicate HP infection at the same time. We need to have in mind that disease is a result of the host-agent (bacterium) interaction that varies in time and possible damage/impairment from the disease

Laringealna maska prema endotrahealnoj intubaciji za adenoidektomiju u jednodnevnoj kirurgiji - iskustvo jednog centra

Adenoidectomy with or without tonsillectomy remains one of the most routinely performed surgical procedures in children. The duration of the procedure is usually less than half an hour and is done in a day surgery setting. Airway management for adenoidectomy can be especially challenging as the airway is shared between the surgeon and the anesthesiologist. The gold standard for airway management is an endotracheal tube (ETT), even though there has been an increase in the use of laryngeal mask airway (LMA) over the past decade. This retrospective study investigated patient data collected over a 4-year period (2016 to 2020). Data included 210 cases in a day surgery setting. We analyzed the choice of airway device and use of neuromuscular blockers and analgesics for pain management. The use of LMA was noted in 67.62% while endotracheal intubation was performed in 32.38% of cases. LMA resulted in fewer respiratory complications compared to ETT (p=0.006). The need for neuromuscular blockers was also lower in the LMA group (p=0.01). There was no statistically significant difference in the intraoperative dose of opioid analgesia (p=0.09). Flexible LMA is a satisfactory alternative to endotracheal intubation for outpatient pediatric adenoidectomy.Adenoidektomija, s tonzilektomijom ili bez nje, jedna je od najčešćih kirurških zahvata u djece. Trajanje zahvata obično je kraće od pola sata i izvodi se u uvjetima dnevne kirurgije. Upravljanje dišnim putovima kod adenoidektomije može biti osobito izazovno, jer se dišni put dijeli između kirurga i anesteziologa. Zlatni standard za upravljanje dišnim putovima je endotrahealni tubus, iako se u posljednjem desetljeću češće rabe laringealne maske (LMA). Provedena je retrospektivna studija na 210 bolesnika operiranih tijekom 4-godišnjeg razdoblja (2016. do 2020.) u dnevnoj kirurgiji. Analizirali smo izbor sredstva za osiguranje dišnog puta, primjenu neuromuskularnih blokatora i analgetika za ublažavanje boli. Primjena LMA zabilježena je u 67,62%, dok je endotrahealna intubacija učinjena u 32,38% slučajeva. Nakon LMA zabilježeno je manje respiracijskih komplikacija u usporedbi s ETT (p=0,006). Potreba za neuromuskularnim blokatorima također je bila manja u skupini LMA (p=0,01). Nije pronađena statistički značajna razlika u intraoperativnoj dozi opioidne analgezije (p=0,09). Fleksibilna LMA je zadovoljavajuća alternativa endotrahealnoj intubaciji za ambulantnu pedijatrijsku adenoidektomiju

Missing risks in opportunistic screening for type 2 diabetes - CroDiabGP study

Aim To examine two methods of extracting risks for undetected type 2 diabetes (T2D): derived from electronic medical record (EMR) and family medicine (FM) assessment during pre-consultation phase. All risks were structured in three lists of patients’ data using Wonca International Classification Committee (WICC). Missing data were detected in each list. Methods A prospective study included a group of 1883 patients (aged 45-70) identified with risks. Risks were assessed based on EMR for continuity variables and FM’s assessment for episodes of disease and personal related information. Patients were categorized with final diagnostic test in normoglycaemia, impaired fasting glycaemia and undetected T2D. Results Total prevalence of diabetes was 10.9% (new 1.4%), of which 59.3% were females; mean age was 57.4. The EMR risks were hypertension in 1274 patients (yes 67.6%, no 27.9%, missing 4.4%), hypolipemic treatment in 690 (yes 36.6%, no 30.9%, miss 32.5%). In the episodes of disease: gestational diabetes mellitus in 31 women (yes 2.8%, missing 97.2%). Personal information: family history of diabetes in 649 (yes 34.5%, no 12.4%, missing 53.1%), overweight in 1412 (yes 75.0%, no 8.4%, missing 16.6%), giving birth to babies >4000g in 11 women (yes 0.9%, missing 99.1%). Overweight alone was the best predictor for undiagnosed type 2 diabetes, OR: 2.11 (CI: 1.41-3.15) (p<.001). Conclusion Two methods of extraction could not detect data for episodes of the disease. In the list of personal information, FMs could not assess overweight for one in six patients and family history for every other patient. The study can stimulate improving coded and structured data in EMR

Scripta in honorem Igor Fisković: zbornik povodom sedamdesetog rođendana

The International Research Centre for Late Antiquity and the Middle Ages prepared a Festschrift in honour of one of its founders, Igor Fisković on the occassion of his 70th birthday. The Festschrift&nbsp; includes works addressing the periods that Igor Fisković has dealt with most, thus reflecting the diversity of his interests, ranging from Late Antiquity to contemporary art, with key emphasis on the Late Middle Ages and early modernity. Due to the diversity and the broad period of time the texts are covering, they have been arranged more or less chronologically. The works focus mainly on the Late Middle Ages and the early modern period, Fisković’s forte and the topic of some of his best writings. There are also several texts addressing the baroque period, which was not one of the honouree’s interests, but they were written by some of his closest friends and members of the generation of his former students who have had prestigious careers. (from the Foreword)Zbornik je pripredio Međunarodni istraživački centar za kasnu antiku i srednji vijek povodom sedamdesetog rođendana jednog od svojih osnivača Igora Fiskovića. Zbornik obuhvaća radove koje pokrivaju razdoblja kojima se Igor Fisković ponajviše bavio, reflektirajući raznolikost njegovih interesa, od početne kasne antike i suvremene umjetnosti, do ključnoga naglaska na kasnom srednjem vijeku i početku modernog doba. Zbog te raznolikosti i širokog vremenskog razdoblja koje pokrivaju, radovi su poredani manje-više kronološki. Ističe se brojem radova upravo kasnosrednjovjekovno doba i početci modernoga, forte u kojem je Igor Fisković dao svoje ponajbolje radove. Uz njih je i više priloga koji pokrivaju razdoblje baroka, kojim se slavljenik nije bavio, no koji su iz pera njegovih najbliskijih prijatelja i one generacije njegovih bivših studenata koji su danas ostvarili ugledne karijere. (iz Predgovora

Scripta in honorem Igor Fisković: zbornik povodom sedamdesetog rođendana

The International Research Centre for Late Antiquity and the Middle Ages prepared a Festschrift in honour of one of its founders, Igor Fisković on the occassion of his 70th birthday. The Festschrift&nbsp; includes works addressing the periods that Igor Fisković has dealt with most, thus reflecting the diversity of his interests, ranging from Late Antiquity to contemporary art, with key emphasis on the Late Middle Ages and early modernity. Due to the diversity and the broad period of time the texts are covering, they have been arranged more or less chronologically. The works focus mainly on the Late Middle Ages and the early modern period, Fisković’s forte and the topic of some of his best writings. There are also several texts addressing the baroque period, which was not one of the honouree’s interests, but they were written by some of his closest friends and members of the generation of his former students who have had prestigious careers. (from the Foreword)Zbornik je pripredio Međunarodni istraživački centar za kasnu antiku i srednji vijek povodom sedamdesetog rođendana jednog od svojih osnivača Igora Fiskovića. Zbornik obuhvaća radove koje pokrivaju razdoblja kojima se Igor Fisković ponajviše bavio, reflektirajući raznolikost njegovih interesa, od početne kasne antike i suvremene umjetnosti, do ključnoga naglaska na kasnom srednjem vijeku i početku modernog doba. Zbog te raznolikosti i širokog vremenskog razdoblja koje pokrivaju, radovi su poredani manje-više kronološki. Ističe se brojem radova upravo kasnosrednjovjekovno doba i početci modernoga, forte u kojem je Igor Fisković dao svoje ponajbolje radove. Uz njih je i više priloga koji pokrivaju razdoblje baroka, kojim se slavljenik nije bavio, no koji su iz pera njegovih najbliskijih prijatelja i one generacije njegovih bivših studenata koji su danas ostvarili ugledne karijere. (iz Predgovora