147 research outputs found
Chronic patients: persons with diabetes frequent attenders in Croatian family practice
Chronic diseases cause high frequency visits and generate the long-term frequent attenders (FAs). The connection between frequent attendance and specific morbidities in the health care systems in transitional Europe has been underestimated. We investigated whether frequent visits of chronic patients in primary care are related to characteristic of chronic disease (diabetes mellitus) and whether this is influenced by the family practice in the transitional health care. We analyzed the number of visits a day time work for 490 persons with diabetes in the period 1997 to 2000. As the cut-off points between frequent attenders and non frequent attenders (NFAs) we used the value of the third quartile (Q3) of visits determined for the sex and age groups in the parallel study in the whole population. The analysis was performed for 23 variables: demographic characteristics of patients, disease characteristic and variables of physician. Logistic regressions were employed to identify the predictors of FAs/NFAs. 56.9% (in 1997) to 62.4% (in 2000) persons with diabetes were FAs, compared to 22.4% to 24.3% FAs patients in the whole population. Logistic regression analysis significantly differentiated the two group of visits with 68% accuracy. 4 variables are significant predictors for FAs/NFAs: diabetes as the main disease (p = 0.0005), diet-only-treatment (p = 0.0062), treatment by secondary care (p = 0.0116), and if glycated hemoglobin test (HbA1c) is determined (p = 0.0272). Understanding the similarities and differences of FAs/NFAs persons with diabetes may be important in improving the care and management of chronic diseases in family medicine in transitional health care systems
Prescribing antibiotics to preschool children in primary health care in Croatia
The use of antibiotics depends on cultural and socioeconomic factors, physician's characteristics as well as on microbiological considerations. Aim of our study was to asses antibiotic prescription among preschool children in primary health care in Croatia in relation to socioeconomic factors, symptoms and diagnoses, and type of health care provider. Retrospective longitudinal survey was conducted in 7 teaching primary health care offices in the Croatian capital of Zagreb during 2004, among 1700 preschool children. Antibiotics were prescribed to 611 (46%) children. Significantly more antibiotics were prescribed to boys (66.7%, P = 0.024) and to children whose parents had lower educational level. Most frequently antibiotics were prescribed for the symptoms such as fever (32%), cough (32.5%), nasal discharge (12%), and for the diagnoses such as respiratory diseases (J00-J99) (40%), infectious and parasitic diseases (A00-A99) (31%), and diseases of the middle ear and mastoid (H60-H95) (15%). Logistic regression analyses also predicted correlation of antibiotic prescriptions with socioeconomic factors, symptoms and diagnoses and health care of pediatrician. Prescription of antibiotics for preschool children in primary health care in Croatia related to socioeconomic factors, type of health care provider, certain symptoms and diagnosis groups which should be taken into account when assessing and planning primary health care for preschool children
Guillain-Barre Syndrome in Patients with Seroconversion of IgG Antibodies to Borrelia Burgdorferi sensu lato
A case of polyneuroradiculitis (Guillain-Barre Syndrome) is presented, which was diagnosed in a 62 year-old man after
progressive weakness in the legs and arms and double vision, preceded by severe pain in the back. Diagnosis was
made on the basis of electromioneurography, a specific finding of cerebrospinal fluid (albumino-citological dissociation),
and the clinical course of the disease. Serological analysis of serum included Borellia Burgdorferi sensu lato (BBSL).
Positive findings (slowing of conduction velocity of sensor and motor neurones, and marked albumino-citological dissociation),
together with the dynamics of these findings on the 33rd, 67th and 101st days and one year and a half after the
first clinical signs of disease, indicated the possibility of BBSL infection. Because of the absence of clear clinical and
serological signs of other infections it was assumed that BBSL might be the possible trigger for Guillain-Barre Syndrome.
The fact that there were no obvious clinical signs of infection with BBSL, only serological, suggests that in the
case of unclear aetiology of Guillain-Barre Syndrome BBSL should not be excluded
Crtica s otvorenja novog stalnog postava Muzeja Cetinske krajine - Sinj
U srpnju 2021. Muzej Cetinske krajine je proslavio 65. godiÅ”njicu osnutka. Ususret ovoj velikoj obljetnici, nakon tri i pol godine obnove, 16. travnja, upriliÄeno je sveÄano otvorenje Muzeja Cetinske krajine i predstavljanje novog stalnog postava. Rekonstrukcija, obnova i opremanje zgrade Muzeja s dvoriÅ”tem realizirane su u okviru integriranog projekta Sinj u sridu ā projekt obnove i ureÄenja jedinstvene kulturne baÅ”tine Sinja koji je sufinanciran
sredstvima Europskog fonda za regionalni razvoj
Crtica s otvorenja novog stalnog postava Muzeja Cetinske krajine - Sinj
U srpnju 2021. Muzej Cetinske krajine je proslavio 65. godiÅ”njicu osnutka. Ususret ovoj velikoj obljetnici, nakon tri i pol godine obnove, 16. travnja, upriliÄeno je sveÄano otvorenje Muzeja Cetinske krajine i predstavljanje novog stalnog postava. Rekonstrukcija, obnova i opremanje zgrade Muzeja s dvoriÅ”tem realizirane su u okviru integriranog projekta Sinj u sridu ā projekt obnove i ureÄenja jedinstvene kulturne baÅ”tine Sinja koji je sufinanciran
sredstvima Europskog fonda za regionalni razvoj
Topical use of antifibrinolytic agents reduces postoperative bleeding: a double-blind, prospective, randomized study
Objective: Postoperative bleeding is still one of the most common complications of cardiac surgery. Antifibrinolytic agents successfully reduce bleeding, but there are controversies concerning adverse effects after their systemic use. By topical application of antifibrinolytic agents in pericardial cavity, most of these effects are avoided. We compared the effects of topically applied aprotinin, tranexamic acid and placebo on postoperative bleeding and transfusion requirements. - - - - - Methods: In this single-center prospective, randomized, double-blind trial, 300 adult cardiac patients were randomized into three groups to receive one million IU of aprotinin (AP group), 2.5g of tranexamic acid (TA group) or placebo (PL group) topically before sternal closure. Groups were comparable with respect to all preoperative and intraoperative variables. Postoperative bleeding, transfusion requirements and hematologic parameters were evaluated. - - - - - Results: Postoperative bleeding within first 12-h period (AP group 433+/-294 [350; 360]ml, TA group 391+/-255 [350; 305]ml, PL group 613+/-505 [525; 348]ml), as well as cumulative blood loss within 24h (AP group 726+/-432 [640; 525]ml, TA group 633+/-343 [545; 335]ml, PL group 903+/-733 [800; 445]ml), showed statistically significant inter-group differences (both p<0.001). Bleeding rates values were significantly higher in placebo group compared to the groups treated with antifibrinolytic agents (AP and TA groups) concerning both variables. Although TA group showed the lowest values, no statistical differences between TA and AP groups were found. Inter-group difference of blood product requirements was not statistically significant. - - - - - Conclusions: Topical use of either tranexamic acid or aprotinin efficiently reduces postoperative bleeding. TA seems to be at least as potent as aprotinin, but potentially safer and with better cost-effectiveness ratio
Clinical pharmacist-led program on medication reconciliation implementation at hospital admission: experience of a single university hospital in Croatia
Aim To evaluate the clinical pharmacist-led medication
reconciliation process in clinical practice by quantifying
and analyzing unintentional medication discrepancies at
hospital admission.
Methods An observational prospective study was conducted
at the Clinical Department of Internal Medicine,
University Hospital Dubrava, during a 1-year period (October
2014 ā September 2015) as a part of the implementation
of Safe Clinical Practice, Medication Reconciliation
of the European Network for Patient Safety and Quality of
Care Joint Action (PASQ JA) project. Patients older than 18
years taking at least one regular prescription medication
were eligible for inclusion. Discrepancies between pharmacistsā
Best Possible Medication History (BPMH) and physiciansā
admission orders were detected and communicated
directly to the physicians to clarify whether the observed
changes in therapy were intentional or unintentional. All
discrepancies were discussed by an expert panel and classified
according to their potential to cause harm.
Results In 411 patients included in the study, 1200 medication
discrepancies were identified, with 202 (16.8%) being
unintentional. One or more unintentional medication
discrepancy was found in 148 (35%) patients. The most frequent
type of unintentional medication discrepancy was
drug omission (63.9%) followed by an incorrect dose (24.2%).
More than half (59.9%) of the identified unintentional medication
discrepancies had the potential to cause moderate to
severe discomfort or clinical deterioration in the patient.
Conclusion Around 60% of medication errors were assessed
as having the potential to threaten the patient safety.
Clinical pharmacist-led medication reconciliation was
shown to be an important tool in detecting medication
discrepancies and preventing adverse patient outcomes.
This standardized medication reconciliation process may
be widely applicable to other health care organizations
and clinical settings
Suplementacija s antioksidansima u terapiji Graves-ove bolesti: uÄinak na ekstracelularne antioksidativne parametre
In this study, the effect of supplementation with a fixed combination of antioxidants (vitamins C and E, beta-carotene and selenium) on concentrations of antioxidative parameters in serum was monitored. Measurements were performed prior to the commencement of therapy and after 30 and 60 days in patients with Graves\u27 disease treated with methimazole. Patients who received extra supplementation with antioxidants (group A, n = 29) attained euthyroidism faster than the patients treated only with methimazole (group B, n = 28). Statistically significant differences were achieved after supplementation with antioxidants for all investigated parameters (uric acid, transferrin, ferritin), except TAS and glucose. Nevertheless, due to the fact that all measured parameters remained within the range of referent values, they may not be proposed as reliable indicators of the level of oxidative stress in Graves\u27 disease.U ovom istraživanju promatran jw uÄinak suplementacije fiksnom kombinacijom antioksidansa (vitamini C i E, Ī²-karoten i selen) na koncentracije pokazatelja antioksidacijske obrane u serume. Mjerenja su obavljena u bolesnika s Graves-ovom boleÅ”Äu lijeÄenih metilmazolom (tiamazolom) prije poÄetka terapije, te nakon 30 i 60 dana. Bolesnici, koji su uz metimazol imali i dodatnu terapiju s antioksidansima (skupina A, n=29), postizali su eutireozu brže od bolesnika koji su bili samo na terapiji metimazolom (skupina B, n=28). Koncencentracije svim mjernih parametara (urata, feritina i transferina), (osim koncentracije TAS-a i glukoze), znaÄajno su se razlikovale meÄu skupinama. UnatoÄ tomu, rezultati ove studije ukazuju na to kako se odreÄivani parametri ne mogu smatrati dovoljno pouzdanim pokazateljima razine oksidacijskog stresa u Graves-ovoj bolesti, radi Äinjenice da su njihove koncentracije tijekom ispitivanja ostale unutar granica referentnih vrijednosti
Comparison of gastrointestinal stability of isothiocyanates from Tropaeolum Majus L. Altum using in vitro and ex vivo digestion methods
Tropaeolum majus L. is an annual herbaceous plant and a member of the Tropaeolaceae family, which belongs to the Brassicales order. It is an excellent source of flavonoids, carotenoids, phenolic acids, vitamin C, and it is a plant that contains the glucosinolate glucotropaeolin. The major degradation product of glucotropaeolin is benzyl isothiocyanate which is known for its various biological activities. In this study, an essential oil was isolated from the seeds of the Tropaeolum majus L. altum plant by microwave-assisted distillation and analysed using the GC-MS technique. Two compounds were identified, benzyl isothiocyanate as the major one (97.81%), and 2-phenylacetonitrile as a minor one (0.80%).
Tropaeolum majus L. altum essential oil and pure benzyl isothiocyanate were then submitted to the two-phase in vitro and ex vivo digestion simulations. The analysis performed by the GC-MS/MS technique showed greater stability of benzyl isothiocyanate from essential oil after in vitro (97.57%), and ex vivo (73.47%) gastric phases of the simulated digestion methods, compared to its stability after in vitro (71.17%) and ex vivo (54.90%) intestinal phases. A similar trend was shown for pure benzyl isothiocyanate
Qualitative Analysis of Dermatoglyphics of the Digito-Palmar Complex in Children with Severe Recessive Perceptively Impaired Hearing
The possible hereditary indicated differences in the ascending family tree was investigated in children with severe recessive perceptively impaired hearing, their parents, and healthy controls, using qualitative analysis of dermatoglyphics of the digito-palmar complex. The c2 test was performed and biological distance was investigated by means according to Hiernaux Dg methods, and presented using Wardās method for the examined groups. The results show that the healthy control group differs from the groups of boys and girls with impaired hearing and also from their fathers mostly in palmar variables. The mothers were biologically more distant from the examined groups of patients, and more similar to the control group of randomly selected healthy female controls. The results indicate polygenic inheritance of sporadic sensoneurial hearing loss
- ā¦