Systemic Connective Tissue Diseases and Stroke

Oštećenje živčanog sustava s nizom kliničkih sindroma, uključujući moždani udar, može se očitovati u raznim multisistemskim bolestima vezivnog tkiva. Moždani udar može se pojaviti rano u tijeku bolesti, može biti blaga ili dominantna lezija. Novije dijagnostičke mogućnosti, poglavito slikovne metode, omogućuju sigurniju dijagnozu moždane lezije u sklopu koje se razvio moždani udar te pružaju nove spoznaje o naravi lezije. Liječenje obično ovisi o aktivnosti osnovne bolesti. Uz bolje poznavanje patogeneze oštećenja živčanog sustava stvara se i mogućnost novih pristupa liječenju.Nervous system disorder with numerous clinical syndromes including stroke can be a manifestation of various multisystem connective tissue diseases. Cerebrovascular accident can develop early in the course of the disease, it can be either mild or dominant lesion. New diagnostic possibilities, particularly imaging methods provide more accurate diagnosis as well as new data on the character of the lesion. Treatment usually depends on the activity of underlying disease. With better understanding of the pathogenesis of nervous system disorder, new treatment modalities will be created

Heart involvement and pulmonary arterial hypertension in patients with systemic sclerosis

U bolesnika sa sistemskom sklerozom često je oštećenje srca koje znatno pridonosi lošijoj prognozi bolesti i povećanoj smrtnosti. Zahvaćanje srca može se očitovati kao miokardna bolest, aritmije, smetnje provodnog sustava, perikardno oštećenje te zatajivanje desnog srca koje najčešće nastaje uslijed plućne arterijske hipertenzije te značajno utječe na progresiju bolesti. Plućna arterijska hipertenzija teška je i progresivna bolest sa znatnim morbiditetom i mortalitetom, sve se češće dijagnosticira. Prikazani su dijagnostički postupci u procjeni oštećenja srca i plućne arterijske hipertenzije u bolesnika sa sistemskom sklerozom. Prikazuju se i današnje mogućnosti liječenja.In patients with systemic sclerosis heart involvement is often manifest, associated with poor prognosis and increased mortality. Cardiac involvement may be manifested by myocardial disease, arrhhythmias, conduction system disturbances, pericardial abnormalities and right heart failure, which develops as a complication of pulmonary arterial hypertension and significantly influences the disease progression. Pulmonary arterial hypertension is a severe and progressive disease with significant morbidity and mortality, being more often diagnosed. Diagnostic methods in evaluation of heart involvement as well as pulmonary arterial hypertension are presented. Today’s treatment modalities are discussed

Neuropsychiatric manifestations of systemic lupus erythematosus

Neurološki i psihijatrijski poremećaji opisuju se u gotovo 70% bolesnika sa sistemskim eritemskim lupusom (SLE). Novi klasifikacijski kriteriji za neuropsihijatrijski SLE obuhvaćaju definicije za 19 sindroma s karakterističkim kliničkim, laboratorijskim i slikovnim prikazima. Bolje dijagnostičke mogućnosti, posebno slikovne metode, pružaju nove podatke o nekim stanjima: demijelinizacijskim promjenama u sklopu SLE, neuropsihijatrijskim oštećenjima povezanim s antifosfolipidnim sindromom. Temeljem neuropsihologijskog testiranja sve se češće postavlja dijagnoza kognitivnog deficita, kao najčešćeg psihijatrijskog poremećaja.Neurologic and psychiatric disorder is reported in up to 70% of patients with systemic lupus erythematosus (SLE). New classification criteria for neuropsychiatric SLE define 19 syndromes with characteristic clinical features, laboratory findings and imaging. Better diagnostic possibilities, particularly imaging methods reveal new data on some conditions: demyelinating disorders in patients with SLE, neuropsychiatric disorders associated with antiphospholipid syndrome. Based on neuropsychological examination the diagnosis of cognitive dysfunction, most common psychiatric impairment, is more often established

Challenges in Implementation of European Standards in Training Requirements

Poslijediplomsko specijalističko usavršavanje temelji se na Povelji o specijalističkom usavršavanju UEMS-a i dokumentu European Training Requirement, European Standards of Postgraduate Medical Specialist Training (ETR). Provedba ETR-a u nacionalnim sustavima donosi izazove u obrazovanju specijalizanta, odgovornosti mentora, ustanovi za provođenje specijalizacije te upravljanju kvalitetom. Glavni je izazov izobrazba s ciljem stjecanja kompetencija (competency based medical education, CBME), implementacija okvira kompetencija CanMEDS. Naglasak je na ocjenjivanju kompetencija na radnom mjestu, uključujući kliničke vještine te profesionalno ponašanje. Procjena napretka specijalizanta provodi se tzv. povjerenim profesionalnim aktivnostima (EPA) u specijalističkim programima. UEMS organizira europske specijalističke ispite. U članku se prikazuje i Bijela knjiga o povezivanju istraživanja, izobrazbe i medicinske prakse, dokument H2020 Projekta Alliance for Life Sciences _ACTIONS.Postgraduate specialist training is based on the UEMS Charter on specialist training in European Community (1993) and the document European Training Requirement, European Standards of Postgraduate Medical Specialist Training (ETR). The implementation of ETR in national systems indicates challenges in the education of trainees, the responsibility of mentors, role of training institution and quality management. The main challenge is competency based medical education (CBME), implementation of the CanMEDS competency framework. Emphasised is workplace assessment, including clinical skills and professional behaviour, the trainee’s progress assessed by the Entrusted Professional Activities (EPA) in specialist programmes. UEMS organises European specialist exams. The article also presents the White paper on combining research, teaching and/or medical practice, of the H2020 Alliance for Life Sciences _ACTIONS Project

RHEUMATOLOGY IN EUROPE IN 2015.

Značenje reumatskih i muskuloskeletnih bolesti u sklopu kroničnih bolesti sve je veće te se analiziraju poteškoće bolesnika u ostvarenju zdravstvene skrbi. U dostupnosti liječenja postoje razlike među europskim državama, primjećuje se utjecaj fi nancijske krize. U dogovoru s članovima Europskog parlamenta raspravlja se o načinima boljeg pristupa bolesnicima kojima je potrebna zdravstvena skrb. Velika pozornost posvećuje se izobrazbi doktora medicine i drugih stručnjaka u području reumatologije na svim razinama obrazovanja. Istraživanje o primjeni programa specijalističkog usavršavanja iz područja reumatologije prema Poglavlju 6 Povelje o specijalističkom usavršavanju liječnika pokazalo je razlike u europskim zemljama. U međuvremenu je Vijeće UEMS-a prihvatilo novu verziju poglavlja o specijalističkoj izobrazbi u reumatologiji (European Training Requirements for Specialty of Rheumatology – European Standards for Postgradute Medical Specialist Training). Program specijalističkog usavršavanja temelji se na stjecanju kompetencija među kojima se ističe i uloga profesionalnog ponašanja. Taj se dokument upućuje državama na prihvaćanje. Radi se na strategiji metode ocjenjivanja specijalizanta u procesu specijalističkog usavršavanja. Priprema se europski e-portfolio za specijalizante i europski specijalistički ispit.One of the main concerns of people with chronic conditions, particularly rheumatic and musculoskeletal diseases, is the availability of quality health care, which is being analyzed. Th ere are diff erences between European countries regarding the access to health care. Th e pressure of the fi nancial crisis has been recognized in making barriers more evident. Representatives of the European Parliament together with stakeholder organizations create policy documents for optimizing access to health care at both the EU and national levels. Great care is taken with the education of medical doctors and other professionals in rheumatology on all educational levels. Based on a recent study, there are similarities and discrepancies in the implementation of the specialty training programs (Chapter 6 of the UEMS Charter of Specialty Training Programmes) across Europe. In the meantime, the UEMS Council has endorsed the new Training Requirements for the Specialty of Rheumatology – European Standards for Postgraduate Medical Specialist Training. Th e training program is competency based, stressing the important role of professional behaviour. Th e document is being forwarded to the national societies in order to be implemented in the European countries. A strategy of assessment methods in the specialty training program is being developed. Work on the e-portfolio for European trainees as well as the European Specialty Board Examination is in progress

Validation of the new classification criteria for systemic lupus erythematosus on a patient cohort from a national referral center: a retrospective study

Aim To validate Systemic Lupus International Collaborating Clinics (SLICC)-12 and American College of Rheumatology (ACR)-97 classification criteria on a patient cohort from the University Hospital Center Zagreb. Methods This retrospective study, conducted from 2014 to 2016, involved 308 patients with systemic lupus erythematosus (SLE) (n = 146) and SLE-allied conditions (n = 162). Patients’ medical charts were evaluated by an expert rheumatologist to confirm the clinical diagnosis, regardless of the number of the ACR-97 criteria met. Overall sensitivity and specificity, as well as the sensitivity and specificity according to disease duration, were compared between ACR- 97 and SLICC-12 classifications. Predictive value for SLE for both classifications was assessed using logistic regression and receiver operating characteristic (ROC) curves. Results The SLICC-12 criteria had significantly higher sensitivity in early disase, which increased with disease duration. The ACR-97 criteria had higher specificity. The specificity of the SLICC-12 criteria was low and decreased with disease duration. Regression analysis demonstrated the superiority of the SLICC-12 classification criteria over the ACR-97 criteria, with areas under the ROC curve of 0.801 and 0.780, respectively. Conclusion Although the SLICC-12 criteria were superior to the ACR-97 and were more sensitive for diagnosing early SLE, their specificity in our population was too low. The sensitivity of the SLICC-12 classification is increased by better defined clinical features within each criterion. Our results contribute to the current initiative for developing new criteria for SLE

Classification and patogenesis of spondyloarthropathies

U radu su prikazani klasifikacija i patogeneza spondiloartropatija.The classification and patogenesis of spondyloarthropathies are presented

Primopredaja i prijelaz bolesnika [Patient handover and transition]

Patient handover is considered to be one of the most delicate medical procedures as well as the most preventable cause of medical error. It takes place at primary, secondary and tertiary healthcare, with specificities at every level of healthcare. Improvement in the quality of patient handover is therefore essential for good medical practice. Accurate and comprehensive communication between medical staff is required for patient safety and continuous adequate healthcare. In this article, we describe recommendations for successful and efficient patient handover and highlight communication errors during the process. Special attention is given to handover of rheumatological patients and transition from pediatric to adult healthcare. Also, we emphasize the necessity of education. Medical staff should be competent in sharing and exchanging relevant information when the patient transfers to another medical care provider. Teaching communication skills has been part of undergraduate and postgraduate curriculum in medical schools. At the University of Zagreb School of Medicine we have introduced a longitudinal six-year course Fundamentals of Medical Skills where special attention is given to communication skills. Nevertheless, medical specialty training still lacks educational contents specialized in patient handover and safe patient discharge

Patient handover and transition

Primopredaja bolesnika smatra se jednim od najdelikatnijih postupaka u medicini i najvažnijim sprječivim uzrokom medicinske pogreške. Ovaj se proces zbiva na svim razinama zdravstvene zaštite: primarnoj, sekundarnoj i tercijarnoj, od kojih svaka ima svoje specifičnosti. Unaprjeđenje kvalitete primopredaje na svakoj razini izrazito je važno. Prikladan i precizan prijenos informacija između medicinskog osoblja nuždan je za sigurnost bolesnika i kontinuiranu zdravstvenu zaštitu. U ovom su članku opisane preporuke za uspješnu i kvalitetnu primopredaju bolesnika te su istaknute pogreške pri komunikaciji i postupku prijelaza u skrb drugom liječniku. Poseban je osvrt dan na primopredaju reumatološkog bolesnika i na prijelaz iz pedijatrijske skrbi u adultnu reumatološku skrb. Osobito je naglašena potreba poučavanja pri komunikaciji i prenošenju podataka tijekom prijelaza bolesnika od jednog liječnika drugomu, iz ustanove u ustanovu. Poučavanje komunikacijskih vještina danas se provodi na medicinskim fakultetima na diplomskoj i poslijediplomskoj razini. Na Medicinskom fakultetu Sveučilišta u Zagrebu uveli smo longitudinalni 6-godišnji predmet Temelji liječničkog umijeća u kojem studente poučavamo komunikaciji. Ipak, ističemo nedovoljan broj nastavnih sadržaja specijalističkog usavršavanja koji obuhvaćaju izobrazbu o primopredaji bolesnika i vještinama otpusta bolesnika.Patient handover is considered to be one of the most delicate medical procedures as well as the most preventable cause of medical error. It takes place at primary, secondary and tertiary healthcare, with specificities at every level of healthcare. Improvement in the quality of patient handover is therefore essential for good medical practice. Accurate and comprehensive communication between medical staff is required for patient safety and continuous adequate healthcare. In this article, we describe recommendations for successful and efficient patient handover and highlight communication errors during the process. Special attention is given to handover of rheumatological patients and transition from pediatric to adult healthcare. Also, we emphasize the necessity of education. Medical staff should be competent in sharing and exchanging relevant information when the patient transfers to another medical care provider. Teaching communication skills has been part of undergraduate and postgraduate curriculum in medical schools. At the Universitiy of Zagreb School of Medicine we have introduced a longitudinal six-year course Fundamentals of Medical Skills where special attention is given to communication skills. Nevertheless, medical specialty training still lacks educational contents specialized in patient handover and safe patient discharge