ESOPHAGEAL TUMORS IN FAMILY PHYSICIAN PRACTICE

Tumori jednjaka su relativno rijetki tumori. Javljaju se tipičnim simptomima u pacijenata koji konzumiraju ljutu hranu, alkohol ili su pušači, te nakon ingestije lužina, a s obzirom na dobru dostupnost, moguće ih je rano otkriti. Posljednjih godina raste incidencija adenokarcinoma u odnosu na planocelularni karcinom, što je povezano s GERB-om i razvojem Barretovog jednjaka. Korištenjem kvalitetnih algoritama u dijagnostici i praćenju rizičnih pacijenata, tumore jednjaka bi trebali otkriti u ranijem stadiju, kako bi liječenje bilo uspješnije.Esophageal tumors are relatively rare. They present with typical symptoms in patients that consume spicy food, alcohol, enjoy cigarette smoking, and after alkaline solution ingestion. Considering their accessibility, they can be diagnosed in early stages. In recent years, the incidence of adenocarcinoma has increased in comparison to squamous cell carcinoma. This surge in the incidence is associated with gastroesophageal refl ux disease and Barrett’s esophagus. Using better algorithms in the diagnosis and follow up of patients at risk, in the years to come we should diagnose patients at earlier stages of the disease

DIAGNOSTIC APPROACH TO PATIENTS WITH CHRONIC KIDNEY DISEASE

Termin Kronične bubrežne bolesti (KBB) prema dogovorenoj defi niciji podrazumijeva urinarnu ekskreciju albumina >30 mg/dan i/ili smanjenje funkcije bubrega defi nirane kao smanjenje procijenjene glomerularne fi ltracije (eGFR) 30 mg/day and/or reduction in kidney function defi ned as a decrease in estimated glomerular fi ltration rate (eGFR) <60 mL/min/1.73 m2 for a period longer than three months, in the presence of kidney tissue damage verifi ed by imaging or histologic methods. In developed world, the fi rst cause of CKD is diabetes, followed by arterial hypertension, and the less frequent causes are infl ammatory disease (glomerulonephritis, interstitial nephritis) and congenital condition (polycystic kidney disease). Currently, there is valid classifi cation under the acronym CGA, where C stands for the cause, G for glomerular fi ltration rate (GFR category) and A for the level of albuminuria category. In early stages, patients usually have no symptoms but there are changes in creatinine values, estimated GFR (eGFR) reduction and presence of albuminuria, especially in patients at risk. Determining the grade of renal impairment is important because of different approaches to treatment, monitoring, expected complications, and patient education. Due to improved diagnostic methods and population aging, CKD is diagnosed ever more increasingly. Family physicians should be familiar with the basic principles of screening and diagnosis of CKD to provide them with appropriate care in collaboration with secondary and tertiary health care

Attitudes of healthcare workers about education in primary health care during the covid-19 pandemic

Opasnost od epidemije zarazne bolesti COVID-19, Ministarstvo zdravstva proglasilo je u ožujku 2020. godine za cijelo područje Hrvatske. Rad u zdravstvu tijekom pandemije doveo je zdravstvene djelatnike u povećani stres i rizik od zaraze. Zdravstveni radnici tijekom pandemije moraju koristiti dodatnu osobnu zaštitnu opremu (OZO) kako bi se zaštitili. Cilj istraživanja bio je saznati stavove zdravstvenih djelatnika u primarnoj zdravstvenoj zaštiti o potrebi za dodatnom edukacijom o pravilnoj uporabi osobne zaštitne opreme. Istraživanje je provedeno od listopada 2020. do siječnja 2021. godine. Odgovori su prikupljeni on-line upitnikom. Obavijest o istraživanju poslana je zdravstvenim djelatnicima na e-mail putem stručnih društava u zdravstvu. Upitnik je ispunilo 184 zdravstvenih djelatnika. Najveća skupina ispitanika bili su liječnici (N=146; 79,3 %). Dodatne poslove zbog COVID-19 bolesti obavljalo je 110 (59,8 %) ispitanika. Među dodatne poslove naveli su rad na trijaži, dežurstva u COVID ambulantama, uzimanje briseva, pregled pacijenata s pozitivnim SARS-CoV-2 nalazom, telefonska dežurstva i informacije za pacijente te uzimanje epidemiološke anamneze kao i izricanje mjera samoizolacije. Edukaciju o osobnoj zaštitnoj opremi tijekom školovanja za sadašnje zanimanje imao je svega 71 ispitanik (38,6 %) od kojih je njih 27 odgovorilo da im je to stečeno znanje bilo dovoljno za siguran rad tijekom epidemije. Većina ispitanika (90 %) navodi da želi ići na dodatnu edukaciju o osobnoj zaštitnoj opremi. Na temelju rezultata može se zaključiti da je edukacija potrebna kako tijekom redovitog obrazovanja tako i kroz kontinuiranu medicinsku edukaciju putem stručnih društava.The danger of the COVID-19 infectious disease epidemic was declared by the Ministry of Health in March 2020 for the entire territory of Croatia. Working in healthcare during the pandemic has put healthcare workers at increased stress and risk of infection. Healthcare workers must use additional personal protective equipment (PPE) during a pandemic to protect themselves from infection. The aim of the research was to find out the attitudes of health care workers in primary health care about the need for additional education on the proper use of personal protective equipment. The survey was conducted from October 2020 to January 2021. Responses were collected through an online questionnaire. Notice of the study was sent to healthcare professionals by e-mail through healthcare professional societies. The questionnaire was completed by 184 health professionals. The largest group of subjects were physicians (N = 146; 79.3%). Additional jobs due to COVID-19 disease were performed by 110 (59.8%) respondents. Additional tasks included work on triage, on-call duty at COVID dispensaries, swabbing, examination of patients with a positive SARS-CoV-2 test, telephone on-call and patient information, and taking an epidemiological history as well as imposing self-isolation measures. Only 71 respondents (38.6%) had education on personal protective equipment during training for their current occupation, of which 27 answered that this acquired knowledge was enough for them to work safely during the epidemic. The majority of respondents (90%) believe that they need additional education on personal protective equipment. Based on the results, it can be concluded that education is needed both during regular education and through continuous medical education through professional societies

POSSIBILITIES OF DIAGNOSTIC AND THERAPEUTIC PROCEDURES IN ASSESSING CHRONIC VENOUS LEG ULCER

Karakteristike rada obiteljskih liječnika su dostupnost i kontinuitet zdravstvene zaštite, pružanje osnovnih dijagnostičkih usluga, efektivnost i učinkovitost. Pri tom rješavamo oko 80 % zdravstvene problematike te nužno pratimo i evaluiramo svoj rad. naša zdravstvena zaštita je orijentirana prema zajednici s preventivno promotivnim konceptom, a imamo i ulogu "vratara” zdravstvenog sustava što dovodi do uštede sredstava uz veću kvalitetu zdravstvene zaštite. Zbrinjavanje kronične rane potkoljenice zahtijeva uvježbani tim obiteljske medicine. Prije odluke o načinu liječenja potrebno je učiniti gležanjski indeks (ABI), kako bismo saznali radi li se o arterijskom ili venskom podrijetlu ulkusa. od dijagnostičko terapijskih postupaka koji su priznati liječniku obiteljske medicine nalazi ih se svega nekoliko: obrada kronične rane i previjanje, što ni u kojem slučaju ne pokriva ni vremenskim normativom, a ni cijenom, kompleksnost ozbiljnog tretmana rane. Uz dobru edukaciju obiteljskih liječnika potrebno je omogućiti propisivanje elastično kompresijskog kompleta koji je zlatni standard u liječenju potkoljeničnog ulkusa, te adekvatno vrednovati rad tima obiteljske medicine koji takvu terapiju provodi.The attributes of general practitioner’s work are accessibility and continuity of health care, maintaining basic diagnostic procedures, productivity and eficiency. We deal with about 80% of health issues and monitor and evaluate our work as well. our health care is oriented toward community with the primary preventive and promoting concept, and we also have a role of "gatekeeper” in health care system, which leads to signiicant savings with better health care quality. Chronic venous leg ulcer assessment requires a well trained team in general practice. Prior to making decision on the course of treatment, it is essential to do ankle brachial index (ABI) which can help us determine whether the origin of ulcer is arterial or venous. There are only a few diagnostic and therapeutic procedures in the acknowledged general practitioner’s domain: assessing chronic wound and folding, which cannot cover the complexity of responsible chronic wound assessment either in time normative or in its price. It is necessary to establish good education of general practitioners and enable prescribing elastic, compressive set, which is the gold standard in chronic wound treatment, as well as appropriately evaluate the general practice team that performs this mode of treatment

Organizational Structure of the Croatian Family Practice: A Longitudinal Study Based on Routinely Collected Data

This study was undertaken with the main aim of determining the trends in the number of family doctors’ (FD), gender and educational structure, working status and the number of patients per FD between 1995 and 2013. As the main source of data collection served the Croatian Health Service Yearbooks and Croatian Health Insurance Fund (CHIF) databases on practices and FDs contracting in 2013. Obtained results indicated that the number of contracted FDs increased until 2007, then decreased, and again increased until 2350 in 2013. Average number of patients on FDs list was 1987 in 2012. Less than 50% FDs were specialist in family medicine, 70.3% of them were self-employed with the CHIF contract, and 81% were women. 123 practices planned by the Network did not have contracting FD in 2013. The lack of FDs, the huge number of patients over the standard number, and the location of the missing practices within the rural communities, together make Croatian FM practices less accessible

Zašto oportunistički probir za preddijabetes i šećernu bolest u obiteljskoj medicini? Proces probira traži prilagodbe

Procijenjeno je da je jedna trećina do jedne polovine osoba sa šećernom bolesti neotkriveno i stoga neliječeno. SZO preporuča   prevenciju i rano otkrivanje bolesti kao važan segment u zaustavljanju epidemijske pojavnosti bolesti. Oportunistički probir na neotkrivenu bolest u ordinacijama obiteljske medicine najprihvatljivija je metoda. Proces se odvija na temelju jedinstva: čimbenika rizika (poznavanja pacijenta i obitelji), prostora u kojem se proces odvija, postupaka intervencije nakon probiranja, liječenja i praćenja pacijenta nakon intervencije. Obiteljskom liječniku potreban je jednostavan postupak koji će provoditi tim obiteljskog liječnika u vremenskim i prostornim kapacitetima prakse koji neće dodatno opteretiti konzultaciju, pacijenta i zdravstveni sustav. Takav postupak može postati rutinski rad liječnika obiteljske medicine. U radu je prikazan model za poboljšanje prikupljanja podataka o rizicima iz elektronske medicinske dokumentacije prema WONCA International Classiffication Commitee (WICC)

CROATIAN GUIDELINES FOR THE PHARMACOTHERAPY OF TYPE 2 DIABETES

Uvod: Hrvatsko društvo za dijabetes i bolesti metabolizma Hrvatskoga liječničkog zbora izradilo je 2011. godine prve nacionalne smjernice o prehrani, edukaciji i samokontroli te farmakološkom liječenju šećerne bolesti tipa 2. Sukladno povećanom broju dostupnih lijekova te novim spoznajama o učinkovitosti i sigurnosti primjene već uključenih lijekova, pokazala se potreba za obnovom postojećih smjernica za farmakološko liječenje šećerne bolesti tipa 2 u Republici ­Hrvatskoj. Sudionici: Kao koautori Smjernica navedeni su svi članovi Hrvatskog društva za dijabetes i bolesti metabolizma Hrvatskoga liječničkog zbora, kao i ostalih uključenih stručnih društava, koji su svojim komentarima i prijedlozima pridonijeli izradi Smjernica. Dokazi: Ove su Smjernice utemeljene na dokazima, prema sustavu GRADE (engl. Grading of Recommendations, Assessment, Development and Evaluation) koji uz razinu dokaza opisuje i snagu preporuke. Zaključci: Individualan pristup temeljen na fiziološkim principima regulacije glikemije nuždan je u liječenju osoba sa šećernom bolesti. Ciljeve liječenja i odabir medikamentne terapije treba prilagoditi oboljeloj osobi, uzimajući u obzir životnu dob, trajanje bolesti, očekivano trajanje života, rizik od hipoglikemije, komorbiditete, razvijene vaskularne i ostale komplikacije, kao i ostale čimbenike. Zbog svega navedenoga od nacionalnog je interesa imati praktične, racionalne i provedive smjernice za farmakološko liječenje šećerne bolesti tipa 2.Introduction: The Croatian Association for Diabetes and Metabolic Disorders of the Croatian Medical Association has issued in 2011 the first national guidelines for the nutrition, education, self-control, and pharmacotherapy of ­diabetes type 2. According to the increased number of available medicines and new evidence related to the effectiveness and safety of medicines already involved in the therapy there was a need for update of the existing guidelines for the ­pharmacotherapy of type 2 diabetes in the Republic of Croatia. Participants: as co-authors of the Guidelines there are listed all members of the Croatian Association for Diabetes and Metabolic Diseases, as well as other representatives of professional societies within the Croatian Medical Association, who have contributed with comments and suggestions to the development of the Guidelines. Evidence: These guidelines are evidence-based, according to the GRADE system (eng. Grading of Recommendations, Assessment, Development and Evaluation), which describes the level of evidence and strength of recommendations. Conclusions: An individual patient approach based on physiological principles in blood glucose control is essential for diabetes’ patients management. Glycemic targets and selection of the pharmacological agents should be tailored to the patient, taking into account the age, duration of disease, life expectancy, risk of hypoglycemia, comorbidities, developed vascular and other complications as well as other factors. Because of all this, is of national interest to have a practical, rational and applicable guidelines for the pharmacotherapy of type 2 diabetes

Hrvatske smjernice za farmakološko liječenje šećerne bolesti tipa 2 [Croatian guidelines for the pharmacotherapy of type 2 diabetes]

Introduction: The Croatian Association for Diabetes and Metabolic Disorders of the Croatian Medical Association has issued in 2011 the first national guidelines for the nutrition, education, self-control, and pharmacotherapy of diabetes type 2. According to the increased number of available medicines and new evidence related to the effectiveness and safety of medicines already involved in the therapy there was a need for update of the existing guidelines for the pharmacotherapy of type 2 diabetes in the Republic of Croatia. Participants: as co-authors of the Guidelines there are listed all members of the Croatian Association for Diabetes and Metabolic Diseases, as well as other representatives of professional societies within the Croatian Medical Association, who have contributed with comments and suggestions to the development of the Guidelines. Evidence: These guidelines are evidence-based, according to the GRADE system (eng. Grading of Recommendations, Assessment, Development and Evaluation), which describes the level of evidence and strength of recommendations. Conclusions: An individual patient approach based on physiological principles in blood glucose control is essential for diabetes' patients management. Glycemic targets and selection of the pharmacological agents should be tailored to the patient, taking into account the age, duration of disease, life expectancy, risk of hypoglyce- mia, comorbidities, developed vascular and other complications as well as other factors. Because of all this, is of national interest to have a practical, rational and applicable guidelines for the pharmacotherapy of type 2 diabetes

Strateško upravljanje markama

U današnje suvremeno doba, vrijeme velikih i ubrzanih promjena na tržištu, marka predstavlja veliki značaj. Mnoga poduzeća nastoje stvoriti jedinstvenu marku odnosno brand - ime koje će privući kupce i poslovne partnere i osigurati uspjeh na tržištu. U društvenom i kulturološkom smislu, utjecaj marke danas je gotovo nemjerljiv. Većina ljudi vjeruje da kupujući određeni proizvod pokazuju tko su i kakvi su. Marka pokazuje moć i razlikovanje od konkurencije i stvara emotivnu vezu s kupcima. Ona predstavlja ime, znak, simbol ili dizajn kombinaciju prethodno navedenog koja određuje tvrtku. Marka, uz proizvod i tvrtku koju predstavlja, uključuje i kvalitetu proizvoda te način poslovanja i komunikaciju s potrošačima. Najveća prednost marke proizlazi iz toga kako je ona pozicionirana u svijesti potrošača, odnosno mogućnosti za njegovo prisjećanje i prepoznavanje. Glavni cilj marke je ostati zapamćena i prepoznatljiva u svijesti potrošača. Cilj ovog rada je prikazati važnost marke i strateškog upravljanja markom za tvrtku.In today's modern era, a time of great and accelerating change in the market, the brand is very important. Many companies are trying to create a single brand actually brand - a name that will attract customers and business partners and to ensure success in the market. In social and cultural terms, the impact of the brand today is almost immeasurable. Most people believe that buying a particular product show who they are and what they are. Mark demonstrates the power and differentiation from the competition and creates an emotional connection with customers. It is the name, symbol or design combination of the foregoing that determines the company. Brand, with the product and the company he represents, including product quality and way of doing business and communicating with consumers. The biggest advantage of the brand stems from the fact that it is positioned in the minds of consumers, and the possibilities for his recall and recognition. The main objective of the brand be remembered and recognized in the minds of consumers. The aim of this study was to show the importance of branding and strategic brand management for the company