30 research outputs found
The development and appraisal of a tool designed to find patients harmed by falsely labelled, falsified (counterfeit) medicines.
To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked FilesFalsely labelled, falsified (counterfeit) medicines (FFCm's) are produced or distributed illegally and can harm patients. Although the occurrence of FFCm's is increasing in Europe, harm is rarely reported. The European Directorate for the Quality of Medicines & Health-Care (EDQM) has therefore coordinated the development and validation of a screening tool.The tool consists of a questionnaire referring to a watch-list of FFCm's identified in Europe, including symptoms of their use and individual risk factors, and a scoring form. To refine the questionnaire and reference method, a pilot-study was performed in 105 self-reported users of watch-list medicines. Subsequently, the tool was validated under "real-life conditions" in 371 patients in 5 ambulatory and in-patient care sites ("sub-studies"). The physicians participating in the study scored the patients and classified their risk of harm as "unlikely" or "probable" (cut-off level: presence of ≥2 of 5 risk factors). They assessed all medical records retrospectively (independent reference method) to validate the risk classification and documented their perception of the tool's value.In 3 ambulatory care sites (180 patients), the tool correctly classified 5 patients as harmed by FFCm's. The positive and negative likelihood ratios (LR+/LR-) and the discrimination power were calculated for two cut-off levels: a) 1 site (50 patients): presence of two risk factors (at 10% estimated health care system contamination with FFCm's): LR + 4.9/LR-0, post-test probability: 35%; b) 2 sites (130 patients): presence of three risk factors (at 5% estimated prevalence of use of non-prescribed medicines (FFCm's) by certain risk groups): LR + 9.7/LR-0, post-test probability: 33%. In 2 in-patient care sites (191 patients), no patient was confirmed as harmed by FFCm's. The physicians perceived the tool as valuable for finding harm, and as an information source regarding risk factors.This "decision aid" is a systematic tool which helps find in medical practice patients harmed by FFCm's. This study supports its value in ambulatory care in regions with health care system contamination and in certain risk groups. The establishment of systematic communication between authorities and the medical community concerning FFCm's, current patterns of use and case reports may sustain positive public health impacts.EDQ
Mišljenje pacijenata o našem radu element u procjeni kvalitete (Pacient Opinion about Ours Work Part of Quality Evaulation)
Mišljenje pacijenta o našem radu važan je element pri određivanju kvalitete tog rada. U suradnji sa članovima Upravnog odbora Hrvatskog društva liječnika obiteljskih doktora, autor je proveo anonimnu anketu na različitim područjima sa sličnom organizacijom službe. Obuhvaćena su područja sjeverozapadne i istočne Hrvatske, izvan najvećih gradova. Cilj istraživanja je bio istražiti stavove pacijenata o našem radu i o problemima koje bi trebalo otkloniti. Korišten je modificirani Europep upitnik (koji se koristi u Europi kod sličnih anketa). Podijeljeno je 10.000 anketnih listića u 100 ordinacija obiteljske medicine (po 100 u svakoj ordinaciji). Anketa je provedena na području Rovinja, Poreča, Umaga, Labina, Opatije, čakovca, čakova i Vinkovaca. Kako je anketa rađena na relativno velikom broju uzoraka, podaci su statistički značajni za anketirana područja. Sve podatke iznad 10% negativnih odgovora smatrali smo značajnim. Postotak negativnih odgovora varirao je od 15-45%, pa se većina pacijenata ipak izrazila pozitivno o našem radu. Na svim ispitanim područjima pacijenti su se požalili na četiri ista problema: »Nedovoljno zanimanje liječnika za njihove probleme, ne pozivanje na sistematske preglede i potrebna cijepljenja, ne pripremanje za specijalistički pregled ili bolnicu i na dugo čekanje u čekaonici ». Na nekim se područjima i kod nekih liječnika javljao i mnogo širi spektar negativnih odgovora, što ukazuje i na određene razlike u kvaliteti zdravstvene zaštite, što je bila potvrda naše postavke, da anketa primarno mora poslužiti nama samima, da bi otklonili nedostatke i poboljšali vlastiti rad.
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
T Helper 1 (Th1) and Th2 Characteristics Start to Develop During T Cell Priming and Are Associated with an Immediate Ability to Induce Immunoglobulin Class Switching
The respective production of specific immunoglobulin (Ig)G2a or IgG1 within 5 d of primary immunization with Swiss type mouse mammary tumor virus [MMTV(SW)] or haptenated protein provides a model for the development of T helper 1 (Th1) and Th2 responses. The antibody-producing cells arise from cognate T cell B cell interaction, revealed by the respective induction of Cγ2a and Cγ1 switch transcript production, on the third day after immunization. T cell proliferation and upregulation of mRNA for interferon γ in response to MMTV(SW) and interleukin 4 in response to haptenated protein also starts during this day. It follows that there is minimal delay in these responses between T cell priming and the onset of cognate interaction between T and B cells leading to class switching and exponential growth. The Th1 or Th2 profile is at least partially established at the time of the first cognate T cell interaction with B cells in the T zone
The solution structure of the human complement regulator CFHR5 reveals a compact dimeric structure by X-ray scattering and analytical ultracentrifugation
Database and Communications Solution for a Blueprint Management Interface
Denna kandidatrapport producerades i anknytning till kursen TDDD96 - Kandidatprojekt i programvaruutveckling som hölls vid Linköpings universitet våren 2022, där åtta studenter utförde ett gemensamt kandidatarbete. Målet med projektet var att utveckla en databas och en kommunikationslösning för ritningshantering till ett redan existerande gränssnitt. Projektet, beställt av BIT Sverige, är en del av en vision att skapa en standardiserad programvara för ritningshantering, logistik och transparens inom byggindustrin. Resultatet av projektet var en prototyp där ritningar, användare och revisioner av ritningar kan sparas och hämtas från en databas med hjälp av en affärslogik. Rapporten beskriver bakgrunden till projektet och den grundläggande teorin inom projektet. Därefter behandlar rapporten metodiken i projektet, däribland projektgruppens utvecklingsprocess med Scrum. Projektets resultat presenteras, och diskuteras sedan tillsammans med metodiken. Slutligen besvaras rapportens frågeställningar. Efter den gemensamma rapporten återfinns de individuella bidrag där gruppens medlemmar fördjupar sig inom olika ämnen relaterade till det projekt som utförts
Database and Communications Solution for a Blueprint Management Interface
Denna kandidatrapport producerades i anknytning till kursen TDDD96 - Kandidatprojekt i programvaruutveckling som hölls vid Linköpings universitet våren 2022, där åtta studenter utförde ett gemensamt kandidatarbete. Målet med projektet var att utveckla en databas och en kommunikationslösning för ritningshantering till ett redan existerande gränssnitt. Projektet, beställt av BIT Sverige, är en del av en vision att skapa en standardiserad programvara för ritningshantering, logistik och transparens inom byggindustrin. Resultatet av projektet var en prototyp där ritningar, användare och revisioner av ritningar kan sparas och hämtas från en databas med hjälp av en affärslogik. Rapporten beskriver bakgrunden till projektet och den grundläggande teorin inom projektet. Därefter behandlar rapporten metodiken i projektet, däribland projektgruppens utvecklingsprocess med Scrum. Projektets resultat presenteras, och diskuteras sedan tillsammans med metodiken. Slutligen besvaras rapportens frågeställningar. Efter den gemensamma rapporten återfinns de individuella bidrag där gruppens medlemmar fördjupar sig inom olika ämnen relaterade till det projekt som utförts