Społeczne, marketingowe i innowacyjne aspekty kreowania zmian w organizacjach

Praca recenzowana / peer-reviewed pape

Dijagnostički izazov sindroma anti-GQ1b: diferencijalna dijagnoza između Miller-Fischerova sindroma i Bickerstaff ova encefalitisa moždanog debla

ABSTRACT – Miller Fisher syndrome (MFS) may be considered as a rare variant of Guillain-Barré syndrome (GBS). Together with GBS, Bickerstaff ’s brainstem encephalitis and acute ophthalmoparesis without ataxia, MFS is in the group of anti-GQ1b syndrome disorders (anti-GQ1b Sy). Among all GBS variants, MFS is distinctive, presenting with acute symptoms of ophthalmoparesis, ataxia and arefl exia, but without progressive limb weakness as the most characteristic symptom of GBS. MFS is a clinical entity based on typical clinical presentation and defi ned symptoms, and the fi nding of specifi c anti-GQ1b antibodies is not suffi cient for MFS diagnosis. Th e objective of this case report is to demonstrate the diversity of anti-GQ1b Sy clinical presentation. Here we describe a case of a male patient with acute bilateral ophthalmoparesis, mydriasis and unilateral right infranuclear facial nerve palsy, in whom muscle tendon refl exes were preserved and no ataxia was present. Serum antiganglioside antibody test was positive for anti-GQ1b antibody, confi rming the presupposed diagnosis of MFS. Although MFS is rare, it should be considered in patients with acute development of ophthalmoplegia. In rare cases of MFS with uncommon presentation, as it was in our case, positive serum antiganglioside antibody test will lead to the right diagnosisSAŽETAK – Miller Fisherov sindrom (MFS) može se smatrati rijetkom varijantom Guillain-Barréova sindroma (GBS). MFS, zajedno s GBS, Bickerstaff ovim encefalitisom moždanog debla (BBE) i akutnom o ft almoparezom (AO) bez ataksije, pripada skupini poremećaja unutar anti-GQ1b sindroma (anti-GQ1b Sy). Između svih varijanta GBS, MFS se manifestira na specifi čan način akutnim razvojem oft almoplegije, ataksije i arefl eksije, no bez progresivne slabosti mišića ekstremiteta kao karakterističnog znaka GBS. MFS je klinički entitet temeljen na tipičnoj kliničkoj slici i određenim simptomima, no nalaz specifi čnih anti-GQ1b protutijela nije dovoljan za dijagnozu MFS. Cilj je ovoga članka prikazati različitosti kliničke prezentacije anti-GQ1b sindroma. Opisujemo slučaj bolesnika s naglim razvojem obostrane oft almoplegije, midrijaze i unilateralne desnostrane infranuklearne pareze ličnog živca, bez ataksije te urednih miotatskih refl eksa. S obzirom na kliničku sliku i razvoj simptoma postavljena je sumnja na MFS, što je potvrđeno i pozitivnim nalazom serumskih anti-GQ1b protutijela. U zaključku, premda se rijetko pojavljuje, na MFS treba pomis liti u diferencijalnoj dijagnozi kod bolesnika s naglim razvojem oftalmoplegije. U rijetkim slučajevima neuobičajene prezentacije MFS-a, kao u našem slučaju, pozitivan nalaz antigangliozidnih protutijela omogućava postavljanje točne dijagnoz

Dijagnostički izazov sindroma anti-GQ1b: diferencijalna dijagnoza između Miller-Fischerova sindroma i Bickerstaff ova encefalitisa moždanog debla

ABSTRACT – Miller Fisher syndrome (MFS) may be considered as a rare variant of Guillain-Barré syndrome (GBS). Together with GBS, Bickerstaff ’s brainstem encephalitis and acute ophthalmoparesis without ataxia, MFS is in the group of anti-GQ1b syndrome disorders (anti-GQ1b Sy). Among all GBS variants, MFS is distinctive, presenting with acute symptoms of ophthalmoparesis, ataxia and arefl exia, but without progressive limb weakness as the most characteristic symptom of GBS. MFS is a clinical entity based on typical clinical presentation and defi ned symptoms, and the fi nding of specifi c anti-GQ1b antibodies is not suffi cient for MFS diagnosis. Th e objective of this case report is to demonstrate the diversity of anti-GQ1b Sy clinical presentation. Here we describe a case of a male patient with acute bilateral ophthalmoparesis, mydriasis and unilateral right infranuclear facial nerve palsy, in whom muscle tendon refl exes were preserved and no ataxia was present. Serum antiganglioside antibody test was positive for anti-GQ1b antibody, confi rming the presupposed diagnosis of MFS. Although MFS is rare, it should be considered in patients with acute development of ophthalmoplegia. In rare cases of MFS with uncommon presentation, as it was in our case, positive serum antiganglioside antibody test will lead to the right diagnosisSAŽETAK – Miller Fisherov sindrom (MFS) može se smatrati rijetkom varijantom Guillain-Barréova sindroma (GBS). MFS, zajedno s GBS, Bickerstaff ovim encefalitisom moždanog debla (BBE) i akutnom o ft almoparezom (AO) bez ataksije, pripada skupini poremećaja unutar anti-GQ1b sindroma (anti-GQ1b Sy). Između svih varijanta GBS, MFS se manifestira na specifi čan način akutnim razvojem oft almoplegije, ataksije i arefl eksije, no bez progresivne slabosti mišića ekstremiteta kao karakterističnog znaka GBS. MFS je klinički entitet temeljen na tipičnoj kliničkoj slici i određenim simptomima, no nalaz specifi čnih anti-GQ1b protutijela nije dovoljan za dijagnozu MFS. Cilj je ovoga članka prikazati različitosti kliničke prezentacije anti-GQ1b sindroma. Opisujemo slučaj bolesnika s naglim razvojem obostrane oft almoplegije, midrijaze i unilateralne desnostrane infranuklearne pareze ličnog živca, bez ataksije te urednih miotatskih refl eksa. S obzirom na kliničku sliku i razvoj simptoma postavljena je sumnja na MFS, što je potvrđeno i pozitivnim nalazom serumskih anti-GQ1b protutijela. U zaključku, premda se rijetko pojavljuje, na MFS treba pomis liti u diferencijalnoj dijagnozi kod bolesnika s naglim razvojem oftalmoplegije. U rijetkim slučajevima neuobičajene prezentacije MFS-a, kao u našem slučaju, pozitivan nalaz antigangliozidnih protutijela omogućava postavljanje točne dijagnoz

Sumnje na nuspojave lijekova anatomsko-terapijsko-kemijske skupine A

Cilj istraživanja: Cilj istraživanja bio je analizirati zaprimljene prijave sumnji na nuspojave lijekova koji pripadaju anatomsko-terapijsko-kemijskoj skupini A – lijekovi s djelovanjem na probavni sustav i mijenu tvari u RH, u razdoblju od 1. siječnja 2014. godine do 31. prosinca 2018. godine. Materijali i metode: Podaci o prijavljenim nuspojavama zatraženi su od HALMED-a. Zaprimljene prijave sumnji na nuspojave lijekova analizirane su s obzirom na sljedeće: dob i spol bolesnika, ozbiljnost nuspojave, prijavitelj nuspojave, najčešće nuspojave, te klasifikacija nuspojava prema organskim sustavima Medicinskog rječnika za regulatorne poslove, MedDRA. Rezultati: U promatranom petogodišnjem razdoblju zaprimljeno je ukupno 1527 prijava sumnji na nuspojavu lijeka, od čega najviše u 2017. godini (386). Nuspojave su najčešće prijavili farmaceuti (41%) i liječnici (40%). Osobe kod kojih su zabilježene prijavljene sumnje na nuspojavu lijeka su u 58% slučajeva bile ženskoga spola, a u najvećem broju slučajeva pripadale su dobnoj skupini od 45 do 64 godine (30%). Od ukupno 1527 zaprimljenih prijava sumnji na nuspojavu, 18% prijava ocjenjeno je ozbiljnim. Najviše prijavljenih nuspojava klasificirano je prema MedDRA-i kao poremećaji probavnoga sustava (40%). Sumnje na nuspojave najčešće su prijavljivane za pantoprazol (13,9%) i metformin (13,5%). Zaključak: Prijavitelji sumnji na nuspojavu lijeka u najvećem su broju slučajeva bili farmaceuti, a sumnje na nuspojave lijekova su u većini slučajeva prijavljene za osobe ženskoga spola. Najčešće prijavljene nuspojave za lijekove ATK skupine A bile su očekivane i nisu zadovoljile uvjete za klasifikaciju kao ozbiljne, te su u najvećem broju slučajeva klasificirane kao poremećaji probavnoga sustava. Najviše prijava sumnji na nuspojavu lijeka u promatranom razdoblju u RH zaprimljeno je za pantoprazol, što je vjerojatno posljedica načina propisivanja i izdavanja pantoprazola koji rezultiraju njegovom širokom i češćom primjenom u odnosu na druge lijekove iz iste skupine

Delphi survey on the most promising areas and methods to improve systematic reviews' production and updating

Background: Systematic reviews (SRs) are invaluable evidence syntheses, widely used in biomedicine and other scientific areas. Tremendous resources are being spent on the production and updating of SRs. There is a continuous need to automatize the process and use the workforce and resources to make it faster and more efficient.Methods: Information gathered by previous EVBRES research was used to construct a questionnaire for round 1 which was partly quantitative, partly qualitative. Fifty five experienced SR authors were invited to participate in a Del‑ phi study (DS) designed to identify the most promising areas and methods to improve the efficient production and updating of SRs. Topic questions focused on which areas of SRs are most time/effort/resource intensive and should be prioritized in further research. Data were analysed using NVivo 12 plus, Microsoft Excel 2013 and SPSS. Thematic analysis findings were used on the topics on which agreement was not reached in round 1 in order to prepare the questionnaire for round 2.Results: Sixty percent (33/55) of the invited participants completed round 1; 44% (24/55) completed round 2. Participants reported average of 13.3 years of experience in conducting SRs (SD 6.8). More than two thirds of the respondents agreed/strongly agreed the following topics should be prioritized: extracting data, literature searching, screen‑ ing abstracts, obtaining and screening full texts, updating SRs, finding previous SRs, translating non-English studies, synthesizing data, project management, writing the protocol, constructing the search strategy and critically appraising. Participants have not considered following areas as priority: snowballing, GRADE-ing, writing SR, deduplication, formulating SR question, performing meta-analysis.Conclusions: Data extraction was prioritized by the majority of participants as an area that needs more research/ methods development. Quality of available language translating tools has dramatically increased over the years (Google translate, DeepL). The promising new tool for snowballing emerged (Citation Chaser). Automation cannot substitute human judgement where complex decisions are needed (GRADE-ing). Trial registration Study protocol was registered at https://osf.io/bp2hu/peer-reviewe

Scripta in honorem Igor Fisković: zbornik povodom sedamdesetog rođendana

The International Research Centre for Late Antiquity and the Middle Ages prepared a Festschrift in honour of one of its founders, Igor Fisković on the occassion of his 70th birthday. The Festschrift  includes works addressing the periods that Igor Fisković has dealt with most, thus reflecting the diversity of his interests, ranging from Late Antiquity to contemporary art, with key emphasis on the Late Middle Ages and early modernity. Due to the diversity and the broad period of time the texts are covering, they have been arranged more or less chronologically. The works focus mainly on the Late Middle Ages and the early modern period, Fisković’s forte and the topic of some of his best writings. There are also several texts addressing the baroque period, which was not one of the honouree’s interests, but they were written by some of his closest friends and members of the generation of his former students who have had prestigious careers. (from the Foreword)Zbornik je pripredio Međunarodni istraživački centar za kasnu antiku i srednji vijek povodom sedamdesetog rođendana jednog od svojih osnivača Igora Fiskovića. Zbornik obuhvaća radove koje pokrivaju razdoblja kojima se Igor Fisković ponajviše bavio, reflektirajući raznolikost njegovih interesa, od početne kasne antike i suvremene umjetnosti, do ključnoga naglaska na kasnom srednjem vijeku i početku modernog doba. Zbog te raznolikosti i širokog vremenskog razdoblja koje pokrivaju, radovi su poredani manje-više kronološki. Ističe se brojem radova upravo kasnosrednjovjekovno doba i početci modernoga, forte u kojem je Igor Fisković dao svoje ponajbolje radove. Uz njih je i više priloga koji pokrivaju razdoblje baroka, kojim se slavljenik nije bavio, no koji su iz pera njegovih najbliskijih prijatelja i one generacije njegovih bivših studenata koji su danas ostvarili ugledne karijere. (iz Predgovora

Scripta in honorem Igor Fisković: zbornik povodom sedamdesetog rođendana

The International Research Centre for Late Antiquity and the Middle Ages prepared a Festschrift in honour of one of its founders, Igor Fisković on the occassion of his 70th birthday. The Festschrift  includes works addressing the periods that Igor Fisković has dealt with most, thus reflecting the diversity of his interests, ranging from Late Antiquity to contemporary art, with key emphasis on the Late Middle Ages and early modernity. Due to the diversity and the broad period of time the texts are covering, they have been arranged more or less chronologically. The works focus mainly on the Late Middle Ages and the early modern period, Fisković’s forte and the topic of some of his best writings. There are also several texts addressing the baroque period, which was not one of the honouree’s interests, but they were written by some of his closest friends and members of the generation of his former students who have had prestigious careers. (from the Foreword)Zbornik je pripredio Međunarodni istraživački centar za kasnu antiku i srednji vijek povodom sedamdesetog rođendana jednog od svojih osnivača Igora Fiskovića. Zbornik obuhvaća radove koje pokrivaju razdoblja kojima se Igor Fisković ponajviše bavio, reflektirajući raznolikost njegovih interesa, od početne kasne antike i suvremene umjetnosti, do ključnoga naglaska na kasnom srednjem vijeku i početku modernog doba. Zbog te raznolikosti i širokog vremenskog razdoblja koje pokrivaju, radovi su poredani manje-više kronološki. Ističe se brojem radova upravo kasnosrednjovjekovno doba i početci modernoga, forte u kojem je Igor Fisković dao svoje ponajbolje radove. Uz njih je i više priloga koji pokrivaju razdoblje baroka, kojim se slavljenik nije bavio, no koji su iz pera njegovih najbliskijih prijatelja i one generacije njegovih bivših studenata koji su danas ostvarili ugledne karijere. (iz Predgovora

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Metodički pristupi u nastavi flaute za učenike s ortodontskim napravama

Ovaj rad bavi se suočavanjem s poteškoćama u nastavi flaute uzrokovanih nošenjem ortodontske naprave. U sklopu diplomskog rada provedeno je istraživanje među učenicima i nastavnicima flaute o teškoćama uzrokovanim nošenjem ortodontske naprave. Istraživanjem se pokazalo kako se učenici i studenti flaute koji su nosili ili nose ortodontsku napravu suočavaju s nizom teškoća u području čistoće tona, kontrole artikulacije, ambažure, usnica, držanja tijela kao i bolova uzrokovanih sviranjem s napravom. Također, prikazuje iskustva nastavnika flaute koji su se u svom radu imali iskustva s navedenom populacijom učenika i studenata kao i utjecaj koji ortodontska naprava može ostaviti na razvoj sviranja instrumenta. Kroz iskustva nastavnika rezultati istraživanja dodatno pružaju uvid u strategije koje se mogu primijeniti u nastavi i pojedine prilagodbe sadržaja te ukazuju na važnost nastavnikove potpore učeniku prilikom savladavanja novonastalih teškoća. Samim time otvaraju prostor za daljnja istraživanja i podizanje svijesti o navedenoj tematici.This paper engages in the topic of difficulty dealing with an orthodontic appliance in flute teaching and contains qualitative research conducted among students and flute teachers on the difficulties caused by wearing an orthodontic appliance. Research has shown that flute students who have worn or are wearing an orthodontic appliance face a number of difficulties in the areas of tone purity, articulation control, embouchure, lips, posture as well as pain caused by playing while wearing the appliance. It also shows the experiences of flute teachers who have met with the above population of students in their work, as well as the impact that an orthodontic appliance can leave on the development of instrument-playing skills. Additionally, through teachers' experiences, the research results provide insight into the strategies that can be applied in teaching, individual adjustments of content and indicate the importance of teacher support to students in overcoming new difficulties and thus open space for further research and awareness raisin