First three months of COVID-19 in Croatia, Slovenia, Serbia and Federation of Bosnia and Herzegovina – comparative assessment of disease control measures

Nesigurnost oko novonastale prijetnje od koronavirusa potaknula je pojedine zemlje na usvajanje raznih mjera za suzbijanje bolesti (engl. disease control measures, DCMs). Ovim istraživanjem usporedili smo mjere za suzbijanje bolesti i epidemijske krivulje u Hrvatskoj, Sloveniji, Federaciji Bosne i Hercegovine i Srbiji u prva tri mjeseca epidemije COVID-19. Analizirani su podaci iz otvorenih izvora o potvrđenim slučajevima COVID-19 i mjerama suzbijanja bolesti. Za usporedbu među zemljama korišteno je sedam referentnih mjera suzbijanja bolesti: zatvaranje obrazovnih institucija, potpuno zatvaranje zemlje (engl. lockdown), zatvaranje granica, zabrana javnog prijevoza, ograničenje kretanja unutar zemlje, ublažavanje mjere zaključavanja i ponovno otvaranje granica. Zabilježeno je proteklo vrijeme od prvog otkrivenog i potvrđenog slučaja bolesti COVID-19 do uvođenja svake mjere za suzbijanje bolesti, kao i vrijeme od proglašenja epidemije do uvođenja svake pojedine mjere. Rezultati usporedno opisuju vremenski tijek uvođenja mjera za suzbijanje bolesti u analiziranim zemljama u odnosu na broj potvrđenih slučajeva.The uncertainty surrounding the emerging coronavirus threat prompted countries to adopt various disease control measures (DCMs). This study compares the DCMs and the epicurves in Croatia, Slovenia, Federation of Bosnia and Herzegovina and Serbia in the first three months of COVID-19 epidemic. The open-source data of COVID-19 confirmed case and the DCMs were analyzed. For comparison between countries, seven benchmark DCMs were used: closure of educational institutions, complete lockdown, borders closure, public transport ban, restriction of movement within the country, easing of the lockdown measure, and the borders re-opening. The time passed from the first detected and confirmed COVID-19 case and each DCM was recorded as well as the time between the epidemic declaration and each DCM. The results describe comparatively the time flow of the DCMs across the countries and relative to the number of confirmed cases

Electronic health record – advantages and obstacles in implementation and usage

Digitalne tehnologije i elektronički zdravstveni zapis (e‑Karton) imaju mogućnost smanjiti vrijeme koje liječnici troše na izradu zdravstvene dokumentacije, što osigurava više vremena za izravnu i kvalitetniju zdravstvenu skrb o pacijentima. Racionalizacijom poslova oko vođenja zdravstvene dokumentacije smanjuje se vrijeme administrativnih obveza te poboljšava efikasnost i zadovoljstvo zdravstvenih radnika. Osim prednosti, utvrđene su i poteškoće i prepreke u implementaciji e‑Kartona: ulazni troškovi, digitalna nepismenost, vrijeme potrebno za edukaciju, problem nepotpunih ili loših digitalnih aplikacija, jezične varijacije i terminološka neusklađenost, medicinsko-pravna usklađenost i interoperabilnost s postojećim računalnim sustavima. Iako nova tehnologija elektronskog vođenja zdravstvenih podataka ima brojne prednosti kako za pacijente, tako i za liječnike i za cjelokupni zdravstveni sustav, prepreke koje postoje moraju se identificirati i riješiti kako bi se osigurala sigurna i učinkovita integracija i provođenje zdravstvene skrbi. Promicanje ovih tema važno je kako bi se kvantitativno i kvalitativno obuhvatili te analizirali svi različiti učinci nastali nakon implementacije e‑Kartona budući da izravno utječu na sigurnost i kvalitetu zdravstvene skrbi.Digital technologies and the electronic health record (EHR) have the ability to reduce the time medical staff spend on documentation, allowing more time for direct and better patient health care. By optimizing work processes for keeping health records, the time required for administrative obligations is reduced, thus improving the efficiency and satisfaction of physicians. There are also various obstacles to the implementation of EHR: input costs of various scales, digital literacy, time for education on the use of ICT, poor EHR solutions, language variations and terminological inconsistencies, medical and legal compliance and interoperability with existing computer systems. Although new electronic health data management has a number of benefits for both patients and physicians and for the health care system, barriers do exist and need to be identified and addressed to ensure secure and effective integration and enforcement. The promotion of these topics is important in order to quantitatively and qualitatively cover and analyze all the different effects that occurred after the implementation of the EHR, as they directly affect the safety and quality of health care

CARE QUALITY FOR PATIENTS WITH CORONARY ARTERY DISEASE IN FAMILY MEDICINE - GUIDELINE IMPLEMENTATION BY TAKING A GLANCE AT THE RISK FACTORS

Uvod: Bolesnici s koronarnom bolešću su velik izazov u skrbi liječnika obiteljske medicine (LOM) zbog brojnih komorbiditeta te primjene mjera sekundarne prevencije kojima se prate i istovremeno korigiraju rizični čimbenici koji se odnose na bolesnika, njegovu okolinu i stil života. Cilj: Istražiti uspješnost LOM-a u primjeni mjera sekundarne prevencije kardiovaskularnih bolesti i pronaći moguće rješenje za poboljšanje kvalitete skrbi. Ispitanici i metode: Opservacijsko istraživanje provedeno je 2017. godine u devet specijalističkih ordinacija obiteljske medicine diljem Hrvatske, a uključivalo je 169 bolesnika koji su ili preboljeli infarkt miokarda i/ili su bili podvrgnuti perkutanoj koronarnoj intervenciji i/ili operaciji aortokoronarnog premoštenja. Praćene su vrijednosti krvnog tlaka, LDL kolesterola i indeksa tjelesne mase, a ispitivano je pridržavanje poželjnih oblika ponašanja (nepušenje, tjelesna aktivnost, pravilna prehrana, redovno uzimanje dokazano djelotvornih lijekova) te prilagodba novom stilu života koja je mjerena Likertovom ljestvicom (1-5) kao i zadovoljstvo liječnika preglednošću elektroničkog zdravstvenog zapisa. Rezultati: Zadovoljavajuće vrijednosti arterijskog tlaka postignute su u 63,2 % ispitanika, razinu LDL kolesterola prema smjernicama imalo je 19,4 %, dok je 25,3 % ispitanika imalo uredan indeks tjelesne mase; 25,1 % ispitanika je i dalje pušilo, dok je 43,2 % ispitanika konzumiralo alkohol. Prehrambene navike promijenilo je 63,7 % ispitanika, a 63,4 % je povećalo svoju tjelesnu aktivnost. LOM je u većini slučajeva proveo savjetovanje oko promjene životnog stila nakon koronarnog incidenta. Liječnici su većinom bili zadovoljni sadržajem i količinom podataka u elektroničkom zdravstvenom zapisu, ali ne i njihove upotrebljivosti u svakodnevnoj, vremenski ograničenoj konzultaciji s bolesnikom. Osmišljeno rješenje u programu Adobe Illustrator® omogućilo bi i olakšalo bolju preglednost rizičnih čimbenika i time bi moglo imati utjecaja na učinkovitiju kontrolu provođenja mjera sekundarne prevencije. Zaključak: Skrb za bolesnike s koronarnom bolešću u obiteljskoj medicini je vrlo kompleksna, a dio kompleksnosti se odnosi na primjenu mjera sekundarne prevencije koje su od vitalne važnosti. Zbog toga je potrebno planirati i osigurati dovoljno vremena za konzultaciju s takvim bolesnicima kako bi se dobio uvid u kontrolu rizičnih čimbenika i pravovremeno učinile promjene sukladno važećim smjernicama. Rezultati istraživanja pokazali su da se u bolesnika svi rizični čimbenici ne nalaze unutar preporučenih vrijednosti te da je jedan od mogućih razloga tome što ne postoji njihov pregledan prikaz u elektroničkom zdravstvenom zapisu. Kvalitetnija skrb mogla bi se postići kada bi postojalo jasno vizualno rješenje stanja rizičnih čimbenika koje je u ovom radu osmišljeno i predloženo u obliku slika koje bi LOM-u dale brzi uvid u “profi l” bolesnika te poboljšale učinkovitost svake konzultacije s obzirom na njeno kratko vremensko ograničenje u svakodnevnim uvjetima rada u ordinacijama obiteljske medicine.Introduction: Patients with coronary artery disease represent a challenge in each family medicine practice because of many comorbidities and the application of secondary prevention measures which represent a tool for tracking and simultaneously correcting risk factors related to the patient, his surroundings and lifestyle. Objective: Explore the effectiveness of family medicine specialists in applying secondary prevention measures in cardiovascular diseases and to find a solution for improving quality of care. Participants and Methods: This observational study, was conducted in 2017. under nine specialised family medicine practices throughout Croatia and included 169 patients who suffered from myocardial infarction and/or underwent percutaneous coronary intervention and/or bypass surgery. Blood pressure, LDL cholesterol and body mass index were measured and it was examined whether the participants were abiding to the advised healthy habits (nonsmoking, physically active, good diet, regular use of medicaments according to the guidelines). Adjustment to the new lifestyle was measured with Likert scale (1-5) and the same scale was used to asses physicians satisfaction with transparency of electronic health record data. Results: 63.2% of participants had recommended values for blood pressure, 19.4% for LDL cholesterol and 25.3% had a normal body mass index according to the guidelines. 25.1% of participants continued to smoke and 43.2% continued alcohol consumption. In terms of diet, a change was observed in 63.7% and physical activity increase in 63.4% of participants. In most cases, after coronary incident, physician consulted them regarding lifestyle changes. Family medicine specialists were mostly pleased with the content and the amount of data in electronic health records, but not with their transparency and ease of use in everyday, usually time constrained, patient - doctor consultations. A software application Adobe Illustrator® was used to visually represent the relevant risk factors which could provide more effective control for conducting secondary prevention measures. Conclusion: The care for coronary artery disease patients in family medicine is very complex, and a part of it is related to providing effective measures of secondary prevention which are of crucial importance. Therefore it is imperative to plan ahead and allow sufficient consultation time to obtain control over the risk factors and make timely changes according to the guidelines. Research results have shown that not all risk factors are within recommended values and one of the reasons could be the lack of clear presentation in the electronic health record. Better quality of care could be achieved with the proposed visual solution using pictures that allows the family physician fast access to the patient’s “profile” and improves efficiency of every consultation despite its constrained duration in everyday conditions

Dextran-coated silver nanoparticles for improved barrier and controlled antimicrobial properties of nanocellulose films used in food packaging

The effect of dextran-coated silver nanoparticles (Ag NPs 12.0 ± 1.9 nm) loading (0−0.42 wt%) on the mechanical, barrier, and antimicrobial properties of thin (50−60 μm) films prepared from cellulose nanofibrils by solvent casting method were studied as eco-friendly and food-preservative packaging materials. The presence of dextran was shown to act not only as a dispersing media for Ag NPs and controlling its release but also as a moisture-resistant sealable additive that, synergetically with reduced oxygen permeability, may preserve the food against bacteria growth. Thus, significantly reduced Oxygen Transmission Rates (from 2.07 to 1.40-0.78 cm3 m−2d−1) and hydrophilicity (from 20.8° to 52.4° for MilliQ water, and from 35-37° to 62-74° for 3 % acetic acid and 0.9 % NaCl simulant solutions), yielding a 99.9 % inhibition of Escherichia coli after five repeated cycles of 24 h exposure to 0.9 % NaCl solution was displayed, supported by a controlled release of Ag+ ions (below the toxicologically harmful threshold, <0.5 mg L-1)

Collaboration between primary and secondary health care

Cilj ovog preglednog rada ja analizirati kvalitetu komunikacije između primarne i sekundarne zdravstvene zaštite kroz sustav upućivanja u različitim sustavima zdravstvene zaštite. Pretraženi su Cochrane Reviews i PubMed baze podataka. Korišteni su ključni pojmovi “Referral and Consultation”- upućivanje i konzultacije, “Gatekeeping”- čuvanje ulaza u zdravstveni sustav te “Primary Health Care”- primarna zdravstvena zaštita. U pregled su uključena tri pregledna članka te jedanaest radova iz časopisa publicirana nakon 1.1.2008. godine. Rezultati su pokazali da su zdravstveni sustavi u kojima postoji “gatekeeping” trošili manje sredstava, osiguravali veću razinu jedankosti u dostupnosti skrbi, ali su imali i negativnih značajki kao što je manje zadovoljstvo bolesnika pruženom uslugom te lošiji ishod preživljenja bolesnika zbog nedovoljne pozornosti liječnika upozoravajućim simptomima i neodgovarajućem upućivanju bolesnika na sekundarnu razinu zaštite. Kao pozitivne intervencije za poboljšanje upućivanja pokazale su se strukturirane smjernice za upućivanje, uključivanje specijalista konzultanata u edukaciju o upućivanju, povećanje kompetencije liječnika opće medicine uz povećanje obujma njegovih funkcija i pruženih usluga, uključivanje specijalista drugih struka u rad ordinacije opće medicine, te dijeljenje odgovornosti upućivanja s drugim liječnikom unutar ustanove. Potrebno je unaprijediti sustave komunikacije između primarne i sekundarne zdravstvene zaštite jer to dovodi do povećanja standarda skrbi za pacijente.The aim of this review was to analyze the quality of communication between primary and secondary health care through the perspective of referral systems in different health care settings. A search of Cochrane reviews and PubMed databases was conducted using keywords “Referral and Consultation”, “Gatekeeping” and “Primary Health Care”. Three systematic reviews and twelve journal articles published after 1.1.2008. were included. The results show that health care systems with gatekeeping utilized less resources, provided higher degree of equality in access to health services, but were shown to have some negative aspects such as lower patient satisfaction with service provided and poorer one-year cancer survival rates due to insufficient GPs level of alertness to early warning symptoms and delay in referral to secondary health care. Generally effective strategies to improve referrals included dissemination of guidelines with structured referral sheets, involvement of consultants in educational activities, providing primary care physicians with greater freedom of utilizing diagnostic procedures and extending the range of their services, involving other medical specialists in primary care setting and requiring a second 'in-house' opinion prior to referral. It is necessary to improve communication interface between primary and secondary health care in order to improve the standard of patient care

Endoscopic diagnostic and surgical orbital approach in canines

The aim of this study is to describe new diagnostic and surgical orbital approaches using video endoscopy in canines. Four different endoscopic approaches were investigated in this study of video endoscopy in cadavers: dorsal transorbital ligament approach via incision of the orbital ligament (DTOLA), dorsal subpalpebral transconjunctival approach (DSTA), ventral subpalpebral transconjunctival approach (VSTA), and transoral orbital approach (TOA). Two additional approaches, the ventral transpalpebral approach (VTA) and dorsal caudal transmuscular approach (DCTA) along with the DTOLA and DSTA were used in clinical patients. The most technically demanding approach was DTOLA; however, it provided the best visualisation of different anterior and posterior orbital structures. Visualisation of primarily the dorsal orbital wall, dorsal portion of the eye globe, and dorsal extraconal space also was achieved by DSTA. The VSTA enabled good visualisation of the ventral orbital floor and the ventral extraconal and intraconal space. In contrast, the TOA provided relatively poor visualisation of orbital structures, limited to the ventral orbital quadrant. Meanwhile, the VTA provided visualisation similar to the VSTA, while DCTA visualisation was limited to the dorsal and caudal orbital space. Orbital endoscopy is an effective and minimally invasive procedure that can be used for diagnostic and surgical orbital procedures

The principles of sustainable development of tourism in the special nature reserve "Gornje Podunavlje" and their impact on the local communities

The development of tourism in protected areas is a particular challenge for the tourism business and the activity of nature conservation. The leading criteria for sustainable tourism in protected areas emphasize the importance of the adoption of certain principles of care, long-term planning and management that integrates nature protection and tourism. In this respect, the paper analyzes their importance in the case of Special Nature Reserve »Gornje Podunavlje« in Vojvodina. After acquiring the status of a special nature reserve, talk about the importance of this area to the tourism of Sombor and Apatin, where it is located, has increased. This trend follows the design of educational and tourist tracks, starting and running events as well as starting tourism businesses in rural households. There could be multiple benefits of this for the local communities

Polyphenol profile and anti-tyrosinase potential of the polypore mushrooms Formitopsis pinicola and Ganoderma lucidum

Tyrosinase is widely present in plants and mushrooms and is responsible for enzymatic browning reactions in damaged foodstuff. Accordingly, its inhibitors act as anti-browning compounds and have an important role in maintaining food quality. In the cosmetic industry, inhibitors of tyrosinase have important applications as skin-lightening agents. Due to the ability of phenols to react with proteins, the potential of polypore mushrooms methanol extracts to inhibit tyrosinase was investigated. Fresh wild-growing fruiting bodies of the two mushroom species, namely Fomitipsis pinicola and Ganoderma lucidum, were collected from the Kopaonik and Avala mountains, Republic of Serbia. Their methanol extracts were analyzed for the total phenol content (TPC) and phenolic profile using liquid chromatography coupled with mass spectrometry (LC-MS/MS). The tyrosinase inhibitory potential was determined in the reaction solution of 46 units/mL tyrosinase and 2.5 mM of dihydroxyphenylalanine (L-DOPA). Results were expressed as IC50 values, the concentration of extract required for 50% in vitro inhibition. The results showed that TPC levels were from 38.6 to 133.1 mg gallic acid equivalent (GAE) of extract dry weight (DW), with F. pinicola having the highest level. F. pinicola extract displayed the strongest tyrosinase inhibitory activity (0.10 mg/mL) almost comparable with kojic acid (0.079 mg/mL) commonly used as a standard inhibitor of tyrosinase. A very strong and significant correlation between TPC and IC50 values in tyrosinase inhibition was observed (r = - 0.96). Gallic acid (951.12 μg/g extract DW) was found to be the main polyphenol ingredient of F. pinicola extract. In addition, the anti-tyrosinase activity exhibited by investigated methanol extracts could also be attributed to the presence of other phenolic acids like protocatechuic, p-hydroxybenzoic, chlorogenic, vanillic, p-coumaric, and caffeic acid. The results of the present study suggest that methanol extract of the polypore mushrooms F. pinicola and G. lucidum originating from Serbia act as natural tyrosinase inhibitors and are rich sources of phenolic acids. These mushrooms may be a good material for the development of anti-browning additives as well as additives in skin-lightening cosmeceutical formulations