Users’ satisfaction with the primary health care information system in Croatia: a cross-sectional study

Aim To evaluate the primary health care information system from the general practitioner’s (GP) point of view. Methods Sixty-seven Croatian GPs were distributed a questionnaire about characteristics of the GP’s office, overall impression of the application, handling of daily routine information, more sophisticated information needs, and data security, and rated their satisfaction with each component from 1 to 5. We also compared two most frequently used applications – application with distantly installed software (DIS) and that with locally installed software (LIS, personal computer-based application). Results GPs were most satisfied with the daily procedures and the reminder component of the health information system (rating 4.1). The overall impression ranked second (3.5) and flexibility of applications followed closely (3.4). The most questionable aspect of applications was data security (3.0). LIS system received better overall rate than DIS (4.2 vs 3.2). Conclusion Applications received better ratings for daily routine use than for overall impression and ability to get specific information according the GPs’ needs. Poor ratings on the capability of the application, complaints about unreliable links, and doubts about data security point to a need for more user-friendly interfaces, more information on the capability of the application, and a valid certificate of assessment for every application

Users’ satisfaction with the primary health care information system in Croatia: a cross-sectional study

AIM: To evaluate the primary health care information system from the general practitioner's (GP) point of view. ----- METHODS: Sixty-seven Croatian GPs were distributed a questionnaire about characteristics of the GP's office, overall impression of the application, handling of daily routine information, more sophisticated information needs, and data security, and rated their satisfaction with each component from 1 to 5. We also compared two most frequently used applications--application with distantly installed software (DIS) and that with locally installed software (LIS, personal computer-based application). ----- RESULTS: GPs were most satisfied with the daily procedures and the reminder component of the health information system (rating 4.1). The overall impression ranked second (3.5) and flexibility of applications followed closely (3.4). The most questionable aspect of applications was data security (3.0). LIS system received better overall rate than DIS (4.2 vs 3.2). ----- CONCLUSION: Applications received better ratings for daily routine use than for overall impression and ability to get specific information according the GPs' needs. Poor ratings on the capability of the application, complaints about unreliable links, and doubts about data security point to a need for more user-friendly interfaces, more information on the capability of the application, and a valid certificate of assessment for every application

Pectus excavatum – cosmetic problem or something more?

Introduction: Pectus excavatum, a deformity of the sternum and ribs caused by an unbalanced costochondral hypertrophy, is a congenital abnormality with a prevalence of 1/1000 and it is commonly considered to be an incidental finding without clinical significance. In more advanced cases there may be a considerable compression and relocation of thoracic organs which can lead to serious cardiac or respiratory symptoms.1-3 Case report: 19-year-old male patient was admitted for two-month history of palpitations, shortness of breath and continuous chest pain. Physical exam showed significant pectus excavatum and thoracic lordosis with otherwise normal findings. Resting 12-lead ECG and laboratory tests were normal, including cardiac troponin T levels. 24-hour ECG revealed premature ventricular beats with a paroxysm of non-sustained ventricular tachycardia. Echocardiography (Figure 1) showed normal biventricular size and function and raised suspicion of a large tumor mass compressing the left atrium (LA). No obvious signs of flow obstruction in LA using color and spectral Doppler were noticed. Mitral valve showed billowing of the anterior leaflet with otherwise normal valve function. The next diagnostic step was thoracic CT scan (Figure 2) which revealed extremely thin sagittal thoracic diameter with vertebrae compressing posterior wall of the LA and no signs of a tumor mass. Exercise stress test showed normal functional capacity with no signs of ischemia or arrhythmias in ECG. Patient was started on minimal dose of bisoprolol and follow up 24-hour ECG showed no ventricular arrhythmias. Since CT scan is the gold standard for determining the severity of the pectus excavatum defect, pectus severity index (PSI) was calculated and in our patient the value was 4.8. A normal chest has an average PSI of 2.5 and patients with a PSI of >3.25 are considered candidates for surgery. Patient was scheduled for additional respiratory function tests and will be referred to thoracic surgeon. Conclusion: Severe cases of pectus excavatum can have significant impact on cardiorespiratory function and in those patients, surgery should be considered. On echocardiography, LA compression by vertebrae can even mimic a tumor mass but thoracic CT scan is a gold standard for diagnostic and severity assessment of this condition

The association of beta-fibrinogen – 455G/A gene polymorphism with left atrial thrombus in patient with atrial fibrillation

Uvod: Do sada su poznati brojni prediktori tromboze aurikule lijevog atrija, no u tom je području još uvijek mnogo nepoznanica, pogotovo kada je riječ o genetskim prediktorima. Cilj ovoga istraživanja bio je pronaći genski marker koji može biti prediktor tromboze i time poboljšati procjenu tromboembolijskog rizika. Metode i ispitanici: Dizajnirana je opservacijska, unicentrična, retrospektivna studija koja je uključila ukupno 181 bolesnika s atrijskom fibrilacijom. Primarni ishod istraživanja bio je detekcija tromba u aurikuli lijevoga atrija, a svim bolesnicima rađena je genska analiza na - 455 G/A polimorfizam gena za β lanac fibrinogena. Rezultati: Nakon provedene metode uparivanja prema vjerojatnosti sklonosti dviju skupina bolesnika, niti jedna ispitivana varijabla, uključujući polimorfizam - 455 G/A beta-fibrinogena, nije se pokazala neovisnim prediktorom tromboze aurikule lijevog atrija. Rasprava: Rezultati istraživanja u skladu su s do sada objavljenim studijama, gdje još uvijek postoji nesklad u rezultatima te su neka istraživanja pronašla povezanost - 455 G/A polimorfizma s trombogenezom, dok pak neka druga istraživanja nisu pronašla funkcionalnu vezu. Zaključak: Rezultati upućuju na to da tromboza aurikule lijevoga atrija nije neovisno povezana sa - 455 G/A polimorfizmom za β lanac fibrinogena te je vjerojatno posljedica interakcije između gena, te gena i okoliša. No za dokazivanje navedenoga bit će nužna daljnja istraživanja.Introduction: There are many predictors of left atrial appendage thrombosis, but still there are many unknown facts, articularly in the area of genetic predictors. Purpose of this study was to find genetic predictor of thrombosis and to enhance evaluation of thromboembolic risk. Methods: We conducted an observational, retrospective, unicentric study involving 181 patients with AF. Primary outcome of this study was to detect thrombus in left atrial appendage and all patients were scheduled for genetic analysis for - 55G/A β fibrinogen polymorphism. Results: After performing propensity score matching method, none of tested parameters, including - 455G/A polymorphism, were not independent predictors of left atrial appendage thrombosis. Discussion: This results are consistent with the results from many other studies in this field, where some studies have found functional relationship between thrombosis and - 455G/A polymorphism, but still many other studies have not found the same interaction. Conclusion: Results showed that left atrial appendage thrombosis is not independently related with - 455G/A polymorphism for β chain of fibrinogen. It’s probably consequence of interactions between genes, and genes and environment. However, to confirm such statement we need to conduct more research in the future

The association of beta-fibrinogen – 455G/A gene polymorphism with left atrial thrombus in patient with atrial fibrillation

Uvod: Do sada su poznati brojni prediktori tromboze aurikule lijevog atrija, no u tom je području još uvijek mnogo nepoznanica, pogotovo kada je riječ o genetskim prediktorima. Cilj ovoga istraživanja bio je pronaći genski marker koji može biti prediktor tromboze i time poboljšati procjenu tromboembolijskog rizika. Metode i ispitanici: Dizajnirana je opservacijska, unicentrična, retrospektivna studija koja je uključila ukupno 181 bolesnika s atrijskom fibrilacijom. Primarni ishod istraživanja bio je detekcija tromba u aurikuli lijevoga atrija, a svim bolesnicima rađena je genska analiza na - 455 G/A polimorfizam gena za β lanac fibrinogena. Rezultati: Nakon provedene metode uparivanja prema vjerojatnosti sklonosti dviju skupina bolesnika, niti jedna ispitivana varijabla, uključujući polimorfizam - 455 G/A beta-fibrinogena, nije se pokazala neovisnim prediktorom tromboze aurikule lijevog atrija. Rasprava: Rezultati istraživanja u skladu su s do sada objavljenim studijama, gdje još uvijek postoji nesklad u rezultatima te su neka istraživanja pronašla povezanost - 455 G/A polimorfizma s trombogenezom, dok pak neka druga istraživanja nisu pronašla funkcionalnu vezu. Zaključak: Rezultati upućuju na to da tromboza aurikule lijevoga atrija nije neovisno povezana sa - 455 G/A polimorfizmom za β lanac fibrinogena te je vjerojatno posljedica interakcije između gena, te gena i okoliša. No za dokazivanje navedenoga bit će nužna daljnja istraživanja.Introduction: There are many predictors of left atrial appendage thrombosis, but still there are many unknown facts, articularly in the area of genetic predictors. Purpose of this study was to find genetic predictor of thrombosis and to enhance evaluation of thromboembolic risk. Methods: We conducted an observational, retrospective, unicentric study involving 181 patients with AF. Primary outcome of this study was to detect thrombus in left atrial appendage and all patients were scheduled for genetic analysis for - 55G/A β fibrinogen polymorphism. Results: After performing propensity score matching method, none of tested parameters, including - 455G/A polymorphism, were not independent predictors of left atrial appendage thrombosis. Discussion: This results are consistent with the results from many other studies in this field, where some studies have found functional relationship between thrombosis and - 455G/A polymorphism, but still many other studies have not found the same interaction. Conclusion: Results showed that left atrial appendage thrombosis is not independently related with - 455G/A polymorphism for β chain of fibrinogen. It’s probably consequence of interactions between genes, and genes and environment. However, to confirm such statement we need to conduct more research in the future

The association of beta-fibrinogen – 455G/A gene polymorphism with left atrial thrombus in patient with atrial fibrillation

Uvod: Do sada su poznati brojni prediktori tromboze aurikule lijevog atrija, no u tom je području još uvijek mnogo nepoznanica, pogotovo kada je riječ o genetskim prediktorima. Cilj ovoga istraživanja bio je pronaći genski marker koji može biti prediktor tromboze i time poboljšati procjenu tromboembolijskog rizika. Metode i ispitanici: Dizajnirana je opservacijska, unicentrična, retrospektivna studija koja je uključila ukupno 181 bolesnika s atrijskom fibrilacijom. Primarni ishod istraživanja bio je detekcija tromba u aurikuli lijevoga atrija, a svim bolesnicima rađena je genska analiza na - 455 G/A polimorfizam gena za β lanac fibrinogena. Rezultati: Nakon provedene metode uparivanja prema vjerojatnosti sklonosti dviju skupina bolesnika, niti jedna ispitivana varijabla, uključujući polimorfizam - 455 G/A beta-fibrinogena, nije se pokazala neovisnim prediktorom tromboze aurikule lijevog atrija. Rasprava: Rezultati istraživanja u skladu su s do sada objavljenim studijama, gdje još uvijek postoji nesklad u rezultatima te su neka istraživanja pronašla povezanost - 455 G/A polimorfizma s trombogenezom, dok pak neka druga istraživanja nisu pronašla funkcionalnu vezu. Zaključak: Rezultati upućuju na to da tromboza aurikule lijevoga atrija nije neovisno povezana sa - 455 G/A polimorfizmom za β lanac fibrinogena te je vjerojatno posljedica interakcije između gena, te gena i okoliša. No za dokazivanje navedenoga bit će nužna daljnja istraživanja.Introduction: There are many predictors of left atrial appendage thrombosis, but still there are many unknown facts, articularly in the area of genetic predictors. Purpose of this study was to find genetic predictor of thrombosis and to enhance evaluation of thromboembolic risk. Methods: We conducted an observational, retrospective, unicentric study involving 181 patients with AF. Primary outcome of this study was to detect thrombus in left atrial appendage and all patients were scheduled for genetic analysis for - 55G/A β fibrinogen polymorphism. Results: After performing propensity score matching method, none of tested parameters, including - 455G/A polymorphism, were not independent predictors of left atrial appendage thrombosis. Discussion: This results are consistent with the results from many other studies in this field, where some studies have found functional relationship between thrombosis and - 455G/A polymorphism, but still many other studies have not found the same interaction. Conclusion: Results showed that left atrial appendage thrombosis is not independently related with - 455G/A polymorphism for β chain of fibrinogen. It’s probably consequence of interactions between genes, and genes and environment. However, to confirm such statement we need to conduct more research in the future

Left Ventricular Ejection Fraction Can Predict Atrial Thrombosis Even in Non-High-Risk Individuals with Atrial Fibrillation

Background—Current guidelines do not recommend routine use of transesophageal echocardiography (TOE) in anticoagulated patients with atrial fibrillation (AF). The aim of our study was to identify predictors for left atrial thrombosis (LAT) in patients with AF that would require TOE despite anticoagulation therapy, using clinical, laboratory and echocardiographic data which are usually obtained in those patients in a real-world setting. Methods—We analyzed data from electronic medical records (EMR) of consecutive AF patients referred to two university hospitals between January 2014 and December 2017 for pulmonary vein isolation (PVI) or direct current cardioversion. The primary endpoint was the presence of left atrial thrombus on TOE. Multivariable and univariable logistic regression models were computed using variables that were significantly different between the LAT and the control groups. Results—A total of 838 patients were included, of whom 132 (15.8%) had LAT. After controlling for other variables, only the left ventricle ejection fraction (LVEF) remained statistically significant with an OR of 0.956 (95% CI 0.934–0.979), p p < 0.0001. Conclusions—The LVEF is an independent predictor of LAT, and it might improve thromboembolic risk stratification in future models. LVEF significantly increased the predictive value of the CHA2DS2-Vasc model and was able to identify LAT in non-high-risk patients