40 research outputs found
PROCJENA POTREBNIH RESURSA ZA AB TEHNOLOGIJE GRAÄENJA
Cilj ovoga rada bio je utvrditi potrebne resurse za uspjeÅ”no odvijanje procesa graÄenja armiranim betonom. Opisana je priprema graÄenja i organizacije te je grubo planiran proces graÄenja. Ciljevi pripreme rada su graÄevinski zahvati koordinirani od poÄetka do zavrÅ”etka, odnosno provoÄenje radnih procesa na gradiliÅ”tu bez prekida i smetnji. Pripremom graÄenja se definira moguÄnost provoÄenja ukupnog procesa na najpovoljniji naÄin, planiranjem se uz pomoÄ pokazatelja efikasnosti vrÅ”i procjena graÄenja, a tijekom izvoÄenja radova dobiva potvrda da je to uistinu izvedivo. Pripremom graÄenja se definira moguÄnost provoÄenja ukupnog procesa na najpovoljniji naÄin, planiranjem se na temelju razliÄitih pokazatelja efikasnosti vrÅ”i procjena graÄenja, a tijekom izvoÄenja radova dobiva jasna slika o stvarnim vrijednostima pokazatelja pojedinih radova. Dobra organizacija i pažljivo planiranje procesa graÄenja osnova su za postizanje optimalne pripreme graÄenja, odnosno kvalitetno i uspjeÅ”no odvijanje cjelokupnog procesa graÄenja
Echocardiographic Findings for Non Cardiologists ā How to Read the Report?
Transtorakalna ehokardiografija (TTE) slikovna je metoda koja daje detaljan uvid u morfologiju i funkciju srÄanih struktura i velikih krvnih žila. MoguÄnost prikupljanja velikog broja važnih kliniÄkih informacija, niska cijena i visoka reproducibilnost Äine ju metodom izbora u dijagnostici i praÄenju veÄine kardiovaskularnih bolesti. Å iroka zastupljenost metode sve jasnije nalaže osnovno poznavanje ehokardiografskih naÄela i u zdravstvenih djelatnika koji nisu kardiolozi. Da bi pružio jasnu kliniÄku informaciju, nalaz mora imati jasnu logiÄku strukturu, biti pisan na razumljiv naÄin i sadržavati sva definirana obavezna standardna mjerenja. Radna skupina za slikovne metode u kardiologiji Europskoga kardioloÅ”kog druÅ”tva izdala je preporuke i smjernice za standardizaciju TTE-postupaka i pisanje nalaza, Äiji je cilj unaprijediti kvalitetu informacije koju pruža TTE-izvjeÅ”Äe. Uz obavezne opÄe podatke o bolesniku, kliniÄko pitanje, obavezna standardna mjerenja i datum pretrage, izvjeÅ”Äe mora sadržavati i opisnu interpretaciju mjerenja s kliniÄkom interpretacijom i naglaskom na moguÄim ograniÄenjima pretrage.Transthoracic echocardiography (TTE) is an imaging technique that provides comprehensive evaluation of cardiac and vascular structures and function. Amount and quality of the provided information, low cost and high reproducibility, make it the technique of choice in the diagnosis and follow-up of most of cardiovascular disease. The broad representation of the method requires a basic knowledge of the echocardiographic principles even among health professionals who are not cardiologists. Report should have a clear, logical structure, it should be written in an understandable way, and contain all standard measurements. Working Group on Echocardiography of the European Society of Cardiology has established recommendations and guidelines for standardization of echocardiography performance, dana acquisition and reporting of echocardiographic studies. The aim of these recommendations is to improve the quality of clinical information provided by the TTE report. Mandatory items that should be included in the report include patient identiļ¬cation and demographics, clinical question, standard measurements and the date. The report should also contain a descriptive interpretation of measurements with clinical interpretation and emphasis on the possible limitations of the technique
PODUZETNIÄKI MARKETING I ETIKA - UTJECAJ KULTURE OTKAZIVANJA NA BREND
U uvjetima globalizacije, Å”to podrazumijeva dostupnost informacija iz svih dijelova svijeta, poduzeÄe je samo jedan klik daleko od otkazivanja. Bojkot brenda ali i osoba je neizbježan kada dirnu u tradicionalne vrijednosti. Kultura otkazivanja sve je popularnija praksa povlaÄenja podrÅ”ke javnim osobama i poduzeÄima nakon nekog njihovog negativnog poteza ili izjave kojem se prigovara ili se smatra uvredljivim ili neprihvatljivim. Iz tog razloga danas je sve veÄi fokus na marketingu i vrijednostima za koje se poduzeÄe zalaže, a koje promovira prema javnosti. U ovome su radu dani primjeri poznatih brendova iz Hrvatske i svijeta koji su se naÅ”li na udaru kritika poput brenda Pipi bezalkoholno piÄe i Oreo keksi. U radu su analizirani pojmovi poduzetniÄkog marketinga i etika te odnos vrijednosti brenda i kulture otkazivanja kako bi se pokazali negativni utjecaji i posljedice koje kultura otkazivanja ima na brend. Rezultati istraživanja, navedeni u ovome radu, pokazuju razinu informiranosti hrvatske javnosti o kulturi otkazivanja i koliko sustavi vrijednosti imaju utjecaj na lojalnost brendu
PODUZETNIÄKI MARKETING I ETIKA - UTJECAJ KULTURE OTKAZIVANJA NA BREND
U uvjetima globalizacije, Å”to podrazumijeva dostupnost informacija iz svih dijelova svijeta, poduzeÄe je samo jedan klik daleko od otkazivanja. Bojkot brenda ali i osoba je neizbježan kada dirnu u tradicionalne vrijednosti. Kultura otkazivanja sve je popularnija praksa povlaÄenja podrÅ”ke javnim osobama i poduzeÄima nakon nekog njihovog negativnog poteza ili izjave kojem se prigovara ili se smatra uvredljivim ili neprihvatljivim. Iz tog razloga danas je sve veÄi fokus na marketingu i vrijednostima za koje se poduzeÄe zalaže, a koje promovira prema javnosti. U ovome su radu dani primjeri poznatih brendova iz Hrvatske i svijeta koji su se naÅ”li na udaru kritika poput brenda Pipi bezalkoholno piÄe i Oreo keksi. U radu su analizirani pojmovi poduzetniÄkog marketinga i etika te odnos vrijednosti brenda i kulture otkazivanja kako bi se pokazali negativni utjecaji i posljedice koje kultura otkazivanja ima na brend. Rezultati istraživanja, navedeni u ovome radu, pokazuju razinu informiranosti hrvatske javnosti o kulturi otkazivanja i koliko sustavi vrijednosti imaju utjecaj na lojalnost brendu
Patogeneza bronhijalne hiperreaktivnosti u bolesnika s alergijskim rinitisom
Bronchial hyperreactivity denotes an enhanced bronchial response to usual physiological stimuli, and can manifest with cough or paroxysmal cough through tussive syncope and bronchospasm. Bronchial hyperreactivity can be transient or permanent. Transient bronchial hyperreactivity occurs in acute inflammation of the upper and lower airways, and manifests with dry irritation cough that may persist for up to two months. Permanent bronchial hyperreactivity is found in 10% - 50% of patients with allergic rhinitis, 50% of patients with chronic bronchitis, and 100% of patients with asthma. The pathophysiological mechanism of bronchial hyperreactivity in patients with allergic rhinitis has not yet been fully clarified, however, the following theories have been implicated: loss of nasal function, direct aspiration of inflammatory secretion and antigens, aerogenic transfer of antigens depending on particle size, gastroesophageal reflux, neurogenic mechanisms including the action of neuropeptides in the onset of neurogenic inflammation, and the concept of allergic reaction as a systemic response to local antigen presentation. It should be noted that bronchial hyperreactivity is not asthma; however, the clinical manifestation of asthma is just a matter of time. Therefore, allergic rhinitis should be considered a predisposing factor for the occurrence of asthma.Pod bronhijalnom hiperreaktivnoÅ”Äu podrazumijeva se pojaÄan odgovor bronha na uobiÄajene fizioloÅ”ke podražaje, koji se može oÄitovati kaÅ”ljem, paroksizmom kaÅ”lja, sve do tusigene sinkope i bronhospazma. Bronhijalna hiperreaktivnost može biti prolazna i trajna. Prolazna bronhijalna hiperreaktivnost pojavljuje se kod akutnih upala gornjih i donjih diÅ”nih putova, oÄituje se suhim podražajnim kaÅ”ljem koji može potrajati i do dva mjeseca. Trajna bronhijalna hiperreaktivnost nalazi se u 10% - 50% bolesnika s alergijskim rinitisom, 50% bolesnika s kroniÄnim bronhitisom, te u 100% bolesnika s astmom. PatofizioloÅ”ki mehanizam nastanka bronhijalne hiperreaktivnosti u bolesnika s alergijskim rinitisom nije u potpunosti jasan, a spominju se slijedeÄe teorije: gubitak funkcije nosa, izravna aspiracija upalnog sekreta i antigena, aerogeno prenoÅ”enje antigena ovisno o veliÄini cestica, gastroezofagusni refluks, neurogeni mehanizmi ukljuÄujuÄi i djelovanje neuropeptida u nastanku neurogene upale, te shvaÄanje alergijske reakcije kao sistemske reakcije na lokalno prikazivanje antigena. Valja istaknuti da bronhijalna hiperreaktivnost nije astma, ali je pitanje dana kada Äe se astma kliniÄki oÄitovati. Stoga se alergijski rinitis može smatrati predisponirajuÄim Äimbenikom u pojavi astme
POSTTRAUMATIC STRESS DISORDER AND COMORBID SEXUAL DYSFUNCTIONS
The rates of sexual dysfunctions among patients with
PTSD are much higher than in the general population.
An increasing body of scientific research has confirmed
clinically relevant sexual problems (Letourneau et al.
1997, Kotler et al. 2000, Hossain et al. 2013, Yehuda et
al. 2015, Tran et al. 2015), among which erectile dysfunction
(ED) and premature ejaculation (PE) were the
most frequent (Letourneau et al. 1997). It is important to
underline that patients, particularly military veterans
with PTSD, have an increased risk of sexual dysfunction
independent of the use of psychiatric medications
(Benjamin et al. 2014).
Considering the utilization of pharmacotherapy, data
indicate that over 80% of the veterans treated for PTSD
in the USA have been receiving at least one of the
psychotropic medications (Bernardy et al. 2012). A drug
utilization study conducted in Croatia revealed that the
annual frequency of drug use among pharmacologically
treated PTSD patients was the highest for anxiolytics
(75.83% patients), antidepressants (61.36%), hypnotics
(35.68%) and antipsychotics (30.21%) in 2012 (LeticaCrepulja
et al. 2015). In this context, it is very important
to highlight that a variety of psychotropic medications
recommended for the treatment of PTSD can induce
sexual function disorders (Clayton & Shen 1998, Labbate
2008). Most practice guidelines for the treatment of
PTSD highlight antidepressants as the first-line pharmacotherapeutic
agents, particularly selective serotonin
reuptake inhibitors (SSRIs) (Ballenger et al. 2000,
American Psychiatric Association 2004, National Institute
for Clinical Excellence (NICE) 2005, Baldwin et al.
2005, Forbes et al. 2007) and serotonin-norepinephrine
reuptake inhibitors (SNRIs) (Bandelow et al. 2008,
Benedek et al. 2009, Stein et al. 2009, Department of
Veterans Affairs 2010, World Health Organization
2013, Baldwin et al. 2014). Since the introduction of
these medications, increasing attention has been given
to the side effects, such as sexual dysfunction (Labbate
2008, Corona et al. 2009, Serretti & Chiesa 2011).
SSRIs can negatively affect all domains of sexuality
(desire-arousal-orgasm-resolution) (Corona et al. 2009).
A study of sexual functioning in war veterans with posttraumatic
stress disorder conducted in Croatia showed
that these patients had less sexual activity, hypoactive
sexual desire and more frequent ED compared with
healthy volunteers. These problems might be associated
with the antidepressant therapy (AntiÄeviÄ & BritviÄ
2008). Another Croatian study revealed that the population
exposed to traumatic event(s) had the same level
of sexual functioning (or the same incidence of sexual
dysfunction) regardless of the absence or presence of
PTSD symptoms and their severity (Arbanas 2010).
The aim of this report was to present a patient with
PTSD and comorbid sexual dysfunctions
UltrazvuÄna analiza Å”titnjaÄe u trudnoÄi
The aim of the study was to determine whether pregnancy induced ultrasonographically detectable changes of the thyroid gland. It is a very interesting clinical feature, because some parts of inland Croatia were an endemic goiter area before the implementation of the 1996 act on salt iodination. Sixty-six pregnant women with no history of thyroid disease were repeatedly examined by ultrasound during the course of pregnancy. The size and echostructure of the thyroid were estimated. The thyroid volume increased slightly during pregnancy, but mostly remained within the normal range for particular age. A significant thyroid volume enlargement was observed in third trimester as compared with either first trimester (p=0.02) or control group (p=0.01). Mild goiter of 16% was found in pregnant women in comparison to control group. Morning urine sample, thyroid hormone, TSH and thyroid antibodies were also analyzed in 89 women. Median urine iodine was 8.8 Āµg/dL. Sixty percent of pregnant women had an iodine concentration below 10 Āµg/dL. In four out of nine subjects with goiter, urinary iodine excretion was below 5 Āµg/dL. Elevated serum TSH concentration was recorded in three (3%) women; however, they were euthyroid at the time of the study. Results of the study supported the hypothesis that thyroid volume and thyroid function adapt to the physiologically increased iodine and energy demands. The possible goitrogenic effect of pregnancy could be prevented by an increased iodine intake by diet rich in iodine.U kontinentalnim dijelovima Hrvatske prije uvoÄenja novoga pravilnika o jodiranju soli 1996. godine zabilježena je endemska guÅ”avost. Stoga je svrha ovoga istraživanja bila utvrditi postoji li i u kojoj mjeri guÅ”avost, odnosno poveÄanje volumena Å”titnjaÄu trudnica sa zagrebaÄkog podruÄja. Å ezdeset Å”est zdravih trudnica u kojih prethodno nije postojala bolest Å”titnjaÄe u viÅ”e je navrata pregledano ultrazvukom, pri Äem je odreÄen volumen i ehostruktura Å”titnjaÄe. UtvrÄen je porast volumena Å”titnjaÄe u sva tri trimestra trudnoÄe koji je, meÄutim, prelazio gornju granicu normalne veliÄine Å”titnjaÄe (18 mL) i to uglavnom u treÄem trimestru. ZnaÄajan porast veliÄine Å”titnjaÄe ustanovljen je u treÄem trimestru u odnosu na prvi trimestar (p=0,02) te na kontrolnu skupinu (p=0,01). Umjerena guÅ”a naÄena je u 16% trudnica u odnosu na kontrolnu skupinu. U skupini od 89 trudnica odreÄena je koncentracija joda u mokraÄi, koncentracija hormona Å”titnjaÄe, TSH te tiroidna protutijela. UtvrÄen je medijan koncentracije joda u mokraÄi od 8,8 Āµg/dL, a 60% trudnica imalo je koncentraciju nižu od 10 Āµg/dL. U Äetiri od devet trudnica s ustanovljenom guÅ”om razina joda bila je ispod 5 Āµg/dL. PoviÅ”ena razina TSH u serumu naÄena je u 3% trudnica, ali uz normalne razine hormona Å”titnjaÄe. Ovim smo ispitivanjem potvrdili oÄekivani porast volumena Å”titnjaÄe u trudnoÄi kao posljedicu poveÄane potrebe za energijom i jodom. Stoga zakljuÄujemo da se oÄekivani goitrogeni uÄinak trudnoÄe može sprijeÄiti prehranom obogaÄenom jodom
SIDE-EFFECTS OF GENERIC
New trends in medicine which are much more oriented towards pharmacoeconomy, are ever so common these days. There\u27s an
aim within the focus of the health system which is cutting down treatment expenses, and that relates to psychiatry practice too.
Prescription drugs issued by specialist doctors are allowed to be switched with cheaper ones of the same group of drugs by GP
doctors, with an aim of cost reduction. āInstead of the medicament prescribed, a GP doctor is allowed to prescribe an alternative
medicament of the same efficacy in the dosage of an adequate strengthā (taken from the specialist medical report form).
A 74 years old man is treated for psychotic depression. Exogenic environmental factors caused the symptoms manifestation due
to which hospitalization in a psychiatric ward occurred in two incidences. At the risperidone introduction soon after the second
hospitalization event, a long term remission was obtained which lasted for several years. Despite a stable dose of psychopharmacs,
new episode of the illness occurred. Researching the potential factors which lead towards the aggravation of the course of the illness
disclosed that instead of the original risperidone, the pharmacist issued a generic in an equivalent dose