Prescribers\u27 approval rate of pharmacist-initiated interventions to optimise patients\u27 clinical status of hypertension in the ambulatory care setting

This perspective, pre- and post-intervention study with a one-year follow-up primarily aimed to ascertain prescribers\u27 approval rate of pharmacists\u27 interventions and clinical status of hypertension following comprehensive medication management (CMM) intervention in the ambulatory care clinic. Between January 2018 and January 2022 overall 100 patients with hypertension and other comorbidities were referred to the CMM services at the Health Centre Zagreb – Centar (HCZC). Out of 275 interventions directed to prescribers, 73.1 % of interventions were approved, 12.4 % were rejected and 14.5 % were not reviewed. The percentage of patients with a blood pressure goal increased from 45 % at the initial consultation to 82.5 % at the patients’ latest encounter (p < 0.001). The average number of drug therapy problems (DTPs) per patient totaled 3.53 ± 1.80, where 98 % of patients had one or more DTPs, 48 % had 4 or more DTPs, whereas 26 % had 5 or more DTPs. Subtherapeutic dosage (32.6 %) and the need for additional drug therapy (30.9 %) were the two most commonly identified DTPs. These results reinforce the need to integrate pharmacy-led services in the primary care setting with the aim of improving patients\u27 health outcomes

Chemical composition, antioxidant, and α-Glucosidase-Inhibiting activity of aqueous and hydroethanolic extracts of traditional antidiabetics from croatian ethnomedicine

Type 2 diabetes (T2D) is a chronic disease with a growing prevalence worldwide. In addition to the conventional therapy, many T2D patients use phytotherapeutic preparations. In the present study, chemical composition, antioxidant, and -glucosidase inhibiting activity of traditional antidiabetics from Croatian ethnomedicine (Achillea millefolium, Artemisia absinthium, Centaurium erythraea, Morus alba, Phaseolus vulgaris, Sambucus nigra, and Salvia officinalis) were assessed. The efficacy of water and 80% ethanol as extraction solvents for bioactive constituents was compared. HPLC analysis revealed that the prepared extracts were rich in phenols, especially rutin, ferulic, and chlorogenic acid. Antiradical (against DPPH and ABTS radicals), reducing (towards Mo6+ and Fe3+ ions), and enzyme inhibiting properties were in linear correlation with the content of phenolic constituents. Ethanolic extracts, richer in phenolic substances, showed dominant efficacy in those assays. Aqueous extracts, on the other hand, were better Fe2+ ion chelators and more active in the -carotene linoleic acid assay. Extracts from S. officinalis and A. millefolium were particularly active antioxidants and -glucosidase inhibitors. A. absinthium, another potent -glucosidase inhibitor, contained chromium, a mineral that promotes insulin action. The investigated plants contained significant amounts of minerals useful in management of T2D, with negligible amounts of heavy metals deeming them safe for human use.IP-2018-01-6504info:eu-repo/semantics/publishedVersio

Sveobuhvatna usluga upravljanja farmakoterapijom kao rješenje za propuste u propisivanju lijekova: europska perspektiva

Due to an increase in the prevalence of chronic diseases, medication use and their cost is rising rapidly. This scenario render chronic patients at an increased risk of experiencing drug therapy problems, subsequently leading to unfavourable clinical and economic outcomes. Thus, to ensure patients’ optimal medication use and improve their clinical outcomes, a comprehensive and systematic management of medications is deemed crucial. Hence, Comprehensive Medication Management (CMM) services offered by trained pharmacists can fill this gap by decreasing the unnecessary and often harmful use of medicines and consequent resulting complications. Collaborative practice between pharmacists and gen- eral practitioners, together with patients’ active participation in the definition of treatment regimens, plays an important role in the effectiveness of CMM services. CMM services is defined as the standard of care that ensures each patient’s medications (prescription, non-prescription, alternative, traditional, vitamins, or nutritional supplements) are individ- ually assessed to determine that each medication is appropriate for the patient, effective for the medical condition, safe given the comorbidities and other medications taken, and that the patient is able to take them as intended. It includes an individualized care plan that achieves the intended goals of therapy with appropriate follow-up to determine actual patient outcomes. Apart from the USA, several countries (e.g. Australia, Canada and Brazil) have managed to integrate CMM services into their existing health care system at the primary care level. However, in Europe, in spite of the widespread recog- nition of the need for medication management services, initiation and implementation of CMM services are lagging behind. Hence, for CMM services to become a reality in Europe and elsewhere, numerous prerequisites need to be accomplished, including policies and legal regulations supporting the provision of CMM services on a much larger scale, clearly defined and standardized professional practice and common language shared among the pharmacists, and well trained and experienced practitioners providing full-time, direct patient care.Zbog porasta prevalencije kroničnih bolesti, potrošnja lijekova ubrzano raste. Uslijed toga, kronični bolesnici su izloženi povećanom riziku pojave terapijskih problema što dovodi do nepovoljnih kliničkih i ekonomskih ishoda liječenja. Stoga se smatra da je sveobuhvatno i sustavno upravljanje farmakoterapijom ključno za osiguranje optimalne uporabe lijekova kao i za poboljšanje kliničkih ishoda liječenja. Sveobuhvatna usluga upravljanja farmakoterapijom (engl. Comprehensive Med- ication Management Services, CMM services) koju provode posebno educirani ljekarnici može ponuditi rješenje za ovaj problem, smanjujući nepotrebnu, a često i štetnu primjenu lijekova te njene posljedične komplikacije. Kolaborativna prak- sa ljekarnika i liječnika obiteljske medicine, koja uključuje i aktivno sudjelovanje pacijenata u kreiranju terapijskih režima, važan je čimbenik koji doprinosi učinkovitosti CMM usluge. CMM usluga se definira kao standard skrbi koji osigurava da se svakom pacijentu pojedinačno procjenjuju svi lijekovi (u receptnom ili bezreceptnom režimu, biljni, tradicionalni), vitamini ili dodaci prehrani koje uzima, kako bi se za svaki od njih utvrdilo je li prikladan za pacijenta, je li učinkovit za pacijentovo zdravstveno stanje, je li siguran s obzirom na komorbiditete i druge lijekove koje pacijent uzima, te je li pacijent sposoban i u mogućnosti uzimati lijekove kako treba. Usluga sadrži individualizirani plan skrbi kojim se postižu predviđeni ciljevi terapije kao i odgovarajuće praćenje (follow-up) kako bi se utvrdili stvarni ishodi liječenja. Pored SAD-a, nekoliko je drugih zemalja (Australija, Kanada i Brazil) uspjelo integrirati CMM uslugu u svoje postojeće sustave primarne zdravstvene zaštite. Međutim, u Europi, unatoč raširenosti spoznaje o potrebi za upravljanjem farmakoterapijom, razvoj i implementacija CMM usluge zaostaje. Kako bi se CMM usluge realizirale u Europi i ostalim zemljama, potrebno je ispuniti brojne preduvjete, uključujući donošenje politika i zakonskih propisa koji podržavaju pružanje CMM usluga u mnogo većem obimu, ostvarivanje jasno definirane i standardizirane profesionalne prakse i zajedničkog jezika ljekarnika, te stvaranje dobro educiranih i iskusnih ljekarnika koji u punom radnom vremenu pružaju izravnu skrb pacijentima

Effect of Hydrocortisone on Mortality and Organ Support in Patients With Severe COVID-19: The REMAP-CAP COVID-19 Corticosteroid Domain Randomized Clinical Trial.

Importance: Evidence regarding corticosteroid use for severe coronavirus disease 2019 (COVID-19) is limited. Objective: To determine whether hydrocortisone improves outcome for patients with severe COVID-19. Design, Setting, and Participants: An ongoing adaptive platform trial testing multiple interventions within multiple therapeutic domains, for example, antiviral agents, corticosteroids, or immunoglobulin. Between March 9 and June 17, 2020, 614 adult patients with suspected or confirmed COVID-19 were enrolled and randomized within at least 1 domain following admission to an intensive care unit (ICU) for respiratory or cardiovascular organ support at 121 sites in 8 countries. Of these, 403 were randomized to open-label interventions within the corticosteroid domain. The domain was halted after results from another trial were released. Follow-up ended August 12, 2020. Interventions: The corticosteroid domain randomized participants to a fixed 7-day course of intravenous hydrocortisone (50 mg or 100 mg every 6 hours) (n = 143), a shock-dependent course (50 mg every 6 hours when shock was clinically evident) (n = 152), or no hydrocortisone (n = 108). Main Outcomes and Measures: The primary end point was organ support-free days (days alive and free of ICU-based respiratory or cardiovascular support) within 21 days, where patients who died were assigned -1 day. The primary analysis was a bayesian cumulative logistic model that included all patients enrolled with severe COVID-19, adjusting for age, sex, site, region, time, assignment to interventions within other domains, and domain and intervention eligibility. Superiority was defined as the posterior probability of an odds ratio greater than 1 (threshold for trial conclusion of superiority >99%). Results: After excluding 19 participants who withdrew consent, there were 384 patients (mean age, 60 years; 29% female) randomized to the fixed-dose (n = 137), shock-dependent (n = 146), and no (n = 101) hydrocortisone groups; 379 (99%) completed the study and were included in the analysis. The mean age for the 3 groups ranged between 59.5 and 60.4 years; most patients were male (range, 70.6%-71.5%); mean body mass index ranged between 29.7 and 30.9; and patients receiving mechanical ventilation ranged between 50.0% and 63.5%. For the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively, the median organ support-free days were 0 (IQR, -1 to 15), 0 (IQR, -1 to 13), and 0 (-1 to 11) days (composed of 30%, 26%, and 33% mortality rates and 11.5, 9.5, and 6 median organ support-free days among survivors). The median adjusted odds ratio and bayesian probability of superiority were 1.43 (95% credible interval, 0.91-2.27) and 93% for fixed-dose hydrocortisone, respectively, and were 1.22 (95% credible interval, 0.76-1.94) and 80% for shock-dependent hydrocortisone compared with no hydrocortisone. Serious adverse events were reported in 4 (3%), 5 (3%), and 1 (1%) patients in the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively. Conclusions and Relevance: Among patients with severe COVID-19, treatment with a 7-day fixed-dose course of hydrocortisone or shock-dependent dosing of hydrocortisone, compared with no hydrocortisone, resulted in 93% and 80% probabilities of superiority with regard to the odds of improvement in organ support-free days within 21 days. However, the trial was stopped early and no treatment strategy met prespecified criteria for statistical superiority, precluding definitive conclusions. Trial Registration: ClinicalTrials.gov Identifier: NCT02735707

Utjecaj usluge upravljanja farmakoterapijom na kliničke ishode u pacijenata s kardiovaskularnim bolestima na razini primarne zdravstvene zaštite

Patients with established cardiovascular diseases (CVDs) often use multiple medications that increase the risk of irrational drug use, subsequently leading to unfavourable clinical and health outcomes. New pharmacist's intervention named Comprehensive Medication Management (CMM) services provided at the primary care level could address the abovementioned problem by optimizing patients' therapy and improving their outcomes. Hence, the main aim of this dissertation was to evaluate the impact of CMM services on healthcare utilisation, cardiovascular risk factors and health-related quality of life (HRQoL) among older patients with established CVDs. Moreover, the study aimed to describe the newly implemented practice management system of CMM services at the primary care level and to predict CMM’s budget impact on Croatian health insurance fund. Results showed that the intervention group patients receiving CMM services had significantly lower systolic (p = 0.038) and diastolic blood pressure (p = 0.001), total cholesterol (p = 0.014), low-density lipoprotein cholesterol (p = 0.005), and glycosylated haemoglobin (p = 0.045) in comparison to the control group. Moreover, patients in the control group had 3.35 (95% CI 1.16–10.00) and 2.34 (95% CI 1.52–3.57) times higher number of hospital admissions and unplanned GPs visits compared to the intervention group, respectively. The HRQoL was measured in the intervention group by using the EQ-5D-5L questionnaire. A significant improvement in dimensions “self-care” (p = 0.011) and “usual activities” (p = 0.003) was found. The implementation process included two stages: a pre-implementation stage that set the groundwork for the early implementation stage. The budget impact analysis employed in this research led to a CMM's net budget impact of EUR 92,869 and EUR 0.67 incremental cost per patient within a 3-year horizon, rendering CMM an affordable intervention for the Croatian healthcare system. The results of this dissertation add to the evidence base supporting the CMM’s full implementation in the Croatian health care system by demonstrating that CMM interventions can significantly contribute to better clinical outcomes and lower healthcare utilisation, may improve patients’ HRQoL, thus serving as a viable solution for safety management in older patients with hypertension and established CVDs at the primary care level.Pacijenti s postojećim kardiovaskularnim bolestima (KVB) često koriste veći broj lijekova što vodi k neracionalnoj uporabi lijekova te posljedično doprinosi nepovoljnim kliničkim i zdravstvenim ishodima. Kao posljedica spomenutog pojavila se potreba za uvođenjem nove ljekarničke intervencije usmjerene optimizaciji terapije pacijenata i poboljšanju ishoda - usluge upravljanja farmakoterapijom (UFT). Glavni cilj ovog doktorskog rada bio je utvrditi utjecaj usluge UFT na utilizaciju zdravstvene skrbi, kardiovaskularne rizične čimbenike, i kvalitetu života povezanu sa zdravljem u pacijenata starije životne dobi s KVB. Dodatno, cilj ovog istraživanja bio je opisati cjelokupni proces rane implementacije usluge UFT u Dom zdravlja Zagreb – Centar te procijeniti utjecaj usluge UFT na hrvatski zdravstveni proračun. Ovo je istraživanje pokazalo da su pacijenti u intervencijskoj skupini koji su primali uslugu UFT imali statistički značajno niži sistolički (p = 0,038) i dijastolički krvni tlak (p = 0,001), LDL-kolesterol (p = 0,005), ukupni kolesterol (p = 0,014) i glikirani hemoglobin (p = 0,045) u odnosu na pacijente iz kontrolne skupine. Vjerojatnost hospitalizacije i nenadanih posjeta LOM-u bili su 3,35 (95% CI 1,16-10,00) i 2,34 (95% CI 1,52-3,57) puta veći u kontrolnoj skupini u odnosu na intervencijsku skupinu. Kvaliteta života vezane uz zdravlje pacijenata mjerena je pomoću EQ-5D-5L upitnika u intervencijskoj grupi. Do statistički značajnog poboljšanja došlo je u dvije dimenzije: „skrb o sebi“ (p = 0,011) i „uobičajene aktivnosti“ (p = 0,003). Proces inicijalne implementacije uključivao je dvije faze: pred-implementacijsku fazu (pripremna faza) koja je postavila temelje za fazu rane implementacije. Rezultati studije utjecaja usluge UFT na proračun pokazali su da bi uvođenje usluge UFT u zdravstveni sustav opteretilo proračun u iznosu od 92.869 EUR (po liječenom pacijentu 0,67 EUR) tijekom tri godine što se smatra cjenovno pristupačnom intervencijom. Rezultati ovog doktorskog rada predstavljaju značajan doprinos postojećim dokazima koji podržavaju potpunu implementaciju usluge UFT u hrvatski zdravstveni sustav pokazujući da ova ljekarnička intervencija značajno doprinosi poboljšanju kliničkih ishoda, smanjenju utilizacije zdravstvene skrbi te da može poboljšati kvalitetu života vezanu uz zdravlje, predstavljajući tako održivo rješenje za osiguravanje sigurne terapije pacijenata starije životne dobi s hipertenzijom i KVB na razini primarne zdravstvene zaštite

Utjecaj usluge upravljanja farmakoterapijom na kliničke ishode u pacijenata s kardiovaskularnim bolestima na razini primarne zdravstvene zaštite

Patients with established cardiovascular diseases (CVDs) often use multiple medications that increase the risk of irrational drug use, subsequently leading to unfavourable clinical and health outcomes. New pharmacist's intervention named Comprehensive Medication Management (CMM) services provided at the primary care level could address the abovementioned problem by optimizing patients' therapy and improving their outcomes. Hence, the main aim of this dissertation was to evaluate the impact of CMM services on healthcare utilisation, cardiovascular risk factors and health-related quality of life (HRQoL) among older patients with established CVDs. Moreover, the study aimed to describe the newly implemented practice management system of CMM services at the primary care level and to predict CMM’s budget impact on Croatian health insurance fund. Results showed that the intervention group patients receiving CMM services had significantly lower systolic (p = 0.038) and diastolic blood pressure (p = 0.001), total cholesterol (p = 0.014), low-density lipoprotein cholesterol (p = 0.005), and glycosylated haemoglobin (p = 0.045) in comparison to the control group. Moreover, patients in the control group had 3.35 (95% CI 1.16–10.00) and 2.34 (95% CI 1.52–3.57) times higher number of hospital admissions and unplanned GPs visits compared to the intervention group, respectively. The HRQoL was measured in the intervention group by using the EQ-5D-5L questionnaire. A significant improvement in dimensions “self-care” (p = 0.011) and “usual activities” (p = 0.003) was found. The implementation process included two stages: a pre-implementation stage that set the groundwork for the early implementation stage. The budget impact analysis employed in this research led to a CMM's net budget impact of EUR 92,869 and EUR 0.67 incremental cost per patient within a 3-year horizon, rendering CMM an affordable intervention for the Croatian healthcare system. The results of this dissertation add to the evidence base supporting the CMM’s full implementation in the Croatian health care system by demonstrating that CMM interventions can significantly contribute to better clinical outcomes and lower healthcare utilisation, may improve patients’ HRQoL, thus serving as a viable solution for safety management in older patients with hypertension and established CVDs at the primary care level.Pacijenti s postojećim kardiovaskularnim bolestima (KVB) često koriste veći broj lijekova što vodi k neracionalnoj uporabi lijekova te posljedično doprinosi nepovoljnim kliničkim i zdravstvenim ishodima. Kao posljedica spomenutog pojavila se potreba za uvođenjem nove ljekarničke intervencije usmjerene optimizaciji terapije pacijenata i poboljšanju ishoda - usluge upravljanja farmakoterapijom (UFT). Glavni cilj ovog doktorskog rada bio je utvrditi utjecaj usluge UFT na utilizaciju zdravstvene skrbi, kardiovaskularne rizične čimbenike, i kvalitetu života povezanu sa zdravljem u pacijenata starije životne dobi s KVB. Dodatno, cilj ovog istraživanja bio je opisati cjelokupni proces rane implementacije usluge UFT u Dom zdravlja Zagreb – Centar te procijeniti utjecaj usluge UFT na hrvatski zdravstveni proračun. Ovo je istraživanje pokazalo da su pacijenti u intervencijskoj skupini koji su primali uslugu UFT imali statistički značajno niži sistolički (p = 0,038) i dijastolički krvni tlak (p = 0,001), LDL-kolesterol (p = 0,005), ukupni kolesterol (p = 0,014) i glikirani hemoglobin (p = 0,045) u odnosu na pacijente iz kontrolne skupine. Vjerojatnost hospitalizacije i nenadanih posjeta LOM-u bili su 3,35 (95% CI 1,16-10,00) i 2,34 (95% CI 1,52-3,57) puta veći u kontrolnoj skupini u odnosu na intervencijsku skupinu. Kvaliteta života vezane uz zdravlje pacijenata mjerena je pomoću EQ-5D-5L upitnika u intervencijskoj grupi. Do statistički značajnog poboljšanja došlo je u dvije dimenzije: „skrb o sebi“ (p = 0,011) i „uobičajene aktivnosti“ (p = 0,003). Proces inicijalne implementacije uključivao je dvije faze: pred-implementacijsku fazu (pripremna faza) koja je postavila temelje za fazu rane implementacije. Rezultati studije utjecaja usluge UFT na proračun pokazali su da bi uvođenje usluge UFT u zdravstveni sustav opteretilo proračun u iznosu od 92.869 EUR (po liječenom pacijentu 0,67 EUR) tijekom tri godine što se smatra cjenovno pristupačnom intervencijom. Rezultati ovog doktorskog rada predstavljaju značajan doprinos postojećim dokazima koji podržavaju potpunu implementaciju usluge UFT u hrvatski zdravstveni sustav pokazujući da ova ljekarnička intervencija značajno doprinosi poboljšanju kliničkih ishoda, smanjenju utilizacije zdravstvene skrbi te da može poboljšati kvalitetu života vezanu uz zdravlje, predstavljajući tako održivo rješenje za osiguravanje sigurne terapije pacijenata starije životne dobi s hipertenzijom i KVB na razini primarne zdravstvene zaštite

Ludwig van Beethoven: Klavirski koncert u c-molu, op.37 (instruktivna analiza)

Diplomski rad predstavlja detaljnu formalno-harmonijsku, interpretativnu i tehničku analizu Beethovenova Klavirskog koncerta u c-molu op. 37. , analizu koja bi trebala pomoći kod što vjerodostojnije izvedbe djela

Utjecaj usluge upravljanja farmakoterapijom na kliničke ishode u pacijenata s kardiovaskularnim bolestima na razini primarne zdravstvene zaštite

Patients with established cardiovascular diseases (CVDs) often use multiple medications that increase the risk of irrational drug use, subsequently leading to unfavourable clinical and health outcomes. New pharmacist's intervention named Comprehensive Medication Management (CMM) services provided at the primary care level could address the abovementioned problem by optimizing patients' therapy and improving their outcomes. Hence, the main aim of this dissertation was to evaluate the impact of CMM services on healthcare utilisation, cardiovascular risk factors and health-related quality of life (HRQoL) among older patients with established CVDs. Moreover, the study aimed to describe the newly implemented practice management system of CMM services at the primary care level and to predict CMM’s budget impact on Croatian health insurance fund. Results showed that the intervention group patients receiving CMM services had significantly lower systolic (p = 0.038) and diastolic blood pressure (p = 0.001), total cholesterol (p = 0.014), low-density lipoprotein cholesterol (p = 0.005), and glycosylated haemoglobin (p = 0.045) in comparison to the control group. Moreover, patients in the control group had 3.35 (95% CI 1.16–10.00) and 2.34 (95% CI 1.52–3.57) times higher number of hospital admissions and unplanned GPs visits compared to the intervention group, respectively. The HRQoL was measured in the intervention group by using the EQ-5D-5L questionnaire. A significant improvement in dimensions “self-care” (p = 0.011) and “usual activities” (p = 0.003) was found. The implementation process included two stages: a pre-implementation stage that set the groundwork for the early implementation stage. The budget impact analysis employed in this research led to a CMM's net budget impact of EUR 92,869 and EUR 0.67 incremental cost per patient within a 3-year horizon, rendering CMM an affordable intervention for the Croatian healthcare system. The results of this dissertation add to the evidence base supporting the CMM’s full implementation in the Croatian health care system by demonstrating that CMM interventions can significantly contribute to better clinical outcomes and lower healthcare utilisation, may improve patients’ HRQoL, thus serving as a viable solution for safety management in older patients with hypertension and established CVDs at the primary care level.Pacijenti s postojećim kardiovaskularnim bolestima (KVB) često koriste veći broj lijekova što vodi k neracionalnoj uporabi lijekova te posljedično doprinosi nepovoljnim kliničkim i zdravstvenim ishodima. Kao posljedica spomenutog pojavila se potreba za uvođenjem nove ljekarničke intervencije usmjerene optimizaciji terapije pacijenata i poboljšanju ishoda - usluge upravljanja farmakoterapijom (UFT). Glavni cilj ovog doktorskog rada bio je utvrditi utjecaj usluge UFT na utilizaciju zdravstvene skrbi, kardiovaskularne rizične čimbenike, i kvalitetu života povezanu sa zdravljem u pacijenata starije životne dobi s KVB. Dodatno, cilj ovog istraživanja bio je opisati cjelokupni proces rane implementacije usluge UFT u Dom zdravlja Zagreb – Centar te procijeniti utjecaj usluge UFT na hrvatski zdravstveni proračun. Ovo je istraživanje pokazalo da su pacijenti u intervencijskoj skupini koji su primali uslugu UFT imali statistički značajno niži sistolički (p = 0,038) i dijastolički krvni tlak (p = 0,001), LDL-kolesterol (p = 0,005), ukupni kolesterol (p = 0,014) i glikirani hemoglobin (p = 0,045) u odnosu na pacijente iz kontrolne skupine. Vjerojatnost hospitalizacije i nenadanih posjeta LOM-u bili su 3,35 (95% CI 1,16-10,00) i 2,34 (95% CI 1,52-3,57) puta veći u kontrolnoj skupini u odnosu na intervencijsku skupinu. Kvaliteta života vezane uz zdravlje pacijenata mjerena je pomoću EQ-5D-5L upitnika u intervencijskoj grupi. Do statistički značajnog poboljšanja došlo je u dvije dimenzije: „skrb o sebi“ (p = 0,011) i „uobičajene aktivnosti“ (p = 0,003). Proces inicijalne implementacije uključivao je dvije faze: pred-implementacijsku fazu (pripremna faza) koja je postavila temelje za fazu rane implementacije. Rezultati studije utjecaja usluge UFT na proračun pokazali su da bi uvođenje usluge UFT u zdravstveni sustav opteretilo proračun u iznosu od 92.869 EUR (po liječenom pacijentu 0,67 EUR) tijekom tri godine što se smatra cjenovno pristupačnom intervencijom. Rezultati ovog doktorskog rada predstavljaju značajan doprinos postojećim dokazima koji podržavaju potpunu implementaciju usluge UFT u hrvatski zdravstveni sustav pokazujući da ova ljekarnička intervencija značajno doprinosi poboljšanju kliničkih ishoda, smanjenju utilizacije zdravstvene skrbi te da može poboljšati kvalitetu života vezanu uz zdravlje, predstavljajući tako održivo rješenje za osiguravanje sigurne terapije pacijenata starije životne dobi s hipertenzijom i KVB na razini primarne zdravstvene zaštite

Ludwig van Beethoven: Klavirski koncert u c-molu, op.37 (instruktivna analiza)

Diplomski rad predstavlja detaljnu formalno-harmonijsku, interpretativnu i tehničku analizu Beethovenova Klavirskog koncerta u c-molu op. 37. , analizu koja bi trebala pomoći kod što vjerodostojnije izvedbe djela

Ludwig van Beethoven: Klavirski koncert u c-molu, op.37 (instruktivna analiza)

Diplomski rad predstavlja detaljnu formalno-harmonijsku, interpretativnu i tehničku analizu Beethovenova Klavirskog koncerta u c-molu op. 37. , analizu koja bi trebala pomoći kod što vjerodostojnije izvedbe djela