Racionalna upotreba antibiotika u bolničkim uslovima - studija slučaja

Between 25% and 50% of hospitalized patients receive antibiotics. Some studies estimate that 25-68% of hospital antibiotic prescribing is suboptimal. The aim of this study was to analyse antibiotic use in Medical Center 'Bežanijska Kosa'. For the period 2008-2012, yearly data on antibiotic use in inpatients were obtained from the database of the hospital pharmacy and expressed as DDD per 100 bed-days. The total antibiotic use varied during the study period from 62,3 to 65,6 DDD per 100 bed-days. The most frequently used antibiotics were cephalosporins, followed by fluoroquinolones, penicillins and aminoglycosides. Ceftriaxone was the most frequently prescribed antibiotic. The findings emphasize the need for effective measures to reduce widespread antibiotic misusage in hospitals.Između 25% i 50 % hospitalizovanih pacijenata prima antibiotike. Neke studije procenjuju da je 25-68% antibiotika u Bolnicama propisano neadekvatno. Cilj ovog rada je bio da se Analizira upotreba antibiotika u Kliničko-bolničkom centru 'Bežanijska kosa'. Za period od 2008. do 2012. godine podaci o upotrebi antibiotika na godišnjem nivou su dobijeni iz baze podataka bolničke apoteke i izraženi kao DDD/100 postelja/dan. U toku petogodišnjeg perioda praćenja, ukupna upotreba antibiotika se kretala od 62,3do 65,6 DDD/100 postelja/dan. Najčešće propisivani antibiotici su bili cefalosporini, a zatim fluorohinoloni, penicilini i aminoglikozidi. Ceftriakson je bio najčešće propisivani antibiotik. Ovi rezultati ističu potrebu za sprovođenjem efikasnih mera kako bi se smanjila široko rasprostranjena neadekvatna upotreba antibiotika u stacionarnim zdravstvenim ustanovama

Učinak farmaceuta na kliničke ishode kod pacijenata u palijativnoj nezi - kratak pregled

Pharmacists as the most accessible health care professionals in outpatient settings can improve palliative patient care. The aim of this review was to assess utility of pharmacists (the effectiveness of pharmacists' interventions) on clinical outcomes of patients in palliative care at all levels of health care and in home care. Two electronic databases were searched: PubMed and SCOPUS (last searched August 2014). Primary studies, of any type of research design, in English, related to clinical outcomes of patients in palliative care and pharmacists' interventions were eligible. Studies that used surrogate outcome measures, such as number of pharmacists' recommendations were excluded. A total of 764 reports were found, and only three of them met our inclusion criteria. All of them assessed effects of pharmacists' interventions in outpatient settings and were case series. Symptoms improvement and stabilization of patients' conditions has been the main utility of pharmacists' interventions. Assessed quality of two studies was moderate, and one study had low quality. As number of studies and quality of the evidence were limited, and results of reviewed studies indicate that pharmacists' interventions potentially could improve clinical outcomes of patients in palliative care, more research is needed to provide evidences in this field.Farmaceuti, kao najdostupniji zdravstveni radnici u vanbolničkim uslovima, mogu unaprediti zdravstvenu zaštitu pacijenata u palijativnoj nezi. Cilj ovog pregleda bio je da se proceni učinak farmaceuta (efektivnost intervencija farmaceuta) na kliničke ishode kod pacijenata u palijativnoj nezi na svim nivoima zdravstvene zaštite i u kućnim uslovima. Pretražene su dve elektronske baze naučnih radova: PubMed i SCOPUS (poslednji put u avgustu 2014. godine). Uključeni su originalni naučni radovi na engleskom jeziku, bez obzira na dizajn studije, koji se odnose na kliničke ishode kod pacijenata u palijativnoj nezi i intervencije farmaceuta. Studije koje su koristile surogatne mere ishoda, kao što je broj preporuka farmaceuta, su isključene. Od inicijalno pronađena 764 rada, samo tri su zadovoljila kriterijume za uključivanje u pregled, i svi su se odnosili na intervencije farmaceuta u vanbolničkim uslovima. Sve 3 studije su bile prikazi studija slučajeva. U svim studijama intervencije farmaceuta su dovele do stabilazicije ili poboljšanja simptoma kod pacijenata. Procenjen kvalitet dve studije je bio srednji, a jedna studija je bila lošeg kvaliteta. Kako je broj studija i nivo dokaza ograničen, a rezultati studija ukazuju da intervencije farmaceuta potencijalno mogu imati pozitivan uticaj na kliničke ishode kod pacijenata u palijativnoj nezi, potrebna su dalja istraživanja u ovoj oblasti

Marketing Mix Instruments as Factors of Improvement of Students’ Satisfaction in Higher Education Institutions in Republic of Serbia and Spain

This paper explores the impact of marketing mix instruments on the students’ satisfaction in faculties in the Republic of Serbia and Spain, with the aim of determining how significant the effects of each marketing mix tool and their combinations are in relation to satisfaction of students in Higher Education Institutions (HEIs). The detailed literature review is provided in the theoretical part, which contributes to a better understanding of terms like marketing in higher education, marketing mix instruments in higher education and students’ satisfaction. Data were collected from 896 respondents, who are all students at the faculties in Serbia and Spain, and were obtained using the questionnaire purposefully composed for this research. The methods used to highlight any gaps in this marketing mix practice and the relative customer–student satisfaction in HEIs are statistical analyses (descriptive analysis, correlation analysis, multiple regression analysis and t-independent samples tests), leading to the general conclusions regarding the following: by improving marketing mix instruments (service, distribution, human factor, physical evidence, service process) we can, and by improving (price, promotion) we cannot, improve students’ satisfaction in higher education institutions. The general conclusions clearly highlight what needs to be improved in practice in higher education institutions to improve students’ satisfaction, especially students’ loyalty, students’ choices, students’ satisfaction with the quality of the marketing mix instruments at the faculty, students’ satisfaction with expectation which they had upon enrolment and student satisfaction with the public image of the faculty, which is the main goal of these institutions

Author Correction: Prevalence of potentially inappropriate prescribing in older adults in Central and Eastern Europe: a systematic review and synthesis without meta‑analysis

Link to the corrected article: [https://farfar.pharmacy.bg.ac.rs/handle/123456789/4286

Prevalence of potentially inappropriate prescribing in older adults in Central and Eastern Europe: a systematic review and synthesis without meta-analysis

We aimed to systematically review the prevalence of potentially inappropriate prescribing (PIP) in older adults in Central and Eastern Europe (CEE) in all care settings. We searched Embase and MEDLINE (up to June 2019) and checked the reference lists of the included studies and relevant reviews. Eligible studies used validated explicit or implicit tools to assess the PIP prevalence in older adults in CEE. All study designs were considered, except case‒control studies and case series. We assessed the risk of bias using the Joanna Briggs Institute Prevalence Critical Appraisal Tool and the certainty of evidence using the GRADE approach. Meta-analysis was inappropriate due to heterogeneity in the outcome measurements. Therefore, we used the synthesis without meta-analysis approach—summarizing effect estimates method. This review included twenty-seven studies with 139,693 participants. Most studies were cross-sectional and conducted in high-income countries. The data synthesis across 26 studies revealed the PIP prevalence: the median was 34.6%, the interquartile range was 25.9–63.2%, and the range was 6.5–95.8%. The certainty of this evidence was very low due to the risk of bias, imprecision, and inconsistency. These findings show that PIP is a prevalent issue in the CEE region. Further well-designed studies conducted across countries are needed to strengthen the existing evidence and increase the generalizability of findings

Immunohistochemical Analysis of 4-HNE, NGAL, and HO-1 Tissue Expression after Apocynin Treatment and HBO Preconditioning in Postischemic Acute Kidney Injury Induced in Spontaneously Hypertensive Rats

Oxidative stress has been considered as a central aggravating factor in the development of postischemic acute kidney injury (AKI). The aim of this study was to perform the immunohistochemical analysis of 4-hydroxynonenal (4-HNE), neutrophil gelatinase-associated lipocalin (NGAL), and heme oxygenase-1 (HO-1) tissue expression after apocynin (APO) treatment and hyperbaric oxygenation (HBO) preconditioning, applied as single or combined protocol, in postischemic acute kidney injury induced in spontaneously hypertensive rats (SHR). Twenty-four hours before AKI induction, HBO preconditioning was carried out by exposing to pure oxygen (2.026 bar) twice a day, for 60 min in two consecutive days. Acute kidney injury was induced by removal of the right kidney while the left renal artery was occluded for 45 min by atraumatic clamp. Apocynin was applied in a dose of 40 mg/kg body weight, intravenously, 5 min before reperfusion. We showed increased 4-HNE renal expression in postischemic AKI compared to Sham-operated (SHAM) group. Apocynin treatment, with or without HBO preconditioning, improved creatinine and phosphate clearances, in postischemic AKI. This improvement in renal function was accompanied with decreased 4-HNE, while HO-1 kidney expression restored close to the control group level. NGAL renal expression was also decreased after apocynin treatment, and HBO preconditioning, with or without APO treatment. Considering our results, we can say that 4-HNE tissue expression can be used as a marker of oxidative stress in postischemic AKI. On the other hand, apocynin treatment and HBO preconditioning reduced oxidative damage, and this protective effect might be expected even in experimental hypertensive condition

Hyperbaric oxygen preconditioning and the role of NADPH oxidase inhibition in postischemic acute kidney injury induced in spontaneously hypertensive rats

Renal ischemia/reperfusion injury is a common cause of acute kidney injury (AKI) and hypertension might contribute to the increased incidence of AKI. The purpose of this study was to investigate the effects of single and combined hyperbaric oxygen (HBO) preconditioning and NADPH oxidase inhibition on oxidative stress, kidney function and structure in spontaneously hypertensive rats (SHR) after renal ischemia reperfusion injury. HBO preconditioning was performed by exposing to pure oxygen (2.026 bar) twice a day for two consecutive days for 60 minutes, and 24h before AKI induction. For AKI induction, the right kidney was removed and ischemia was performed by clamping the left renal artery for 45 minutes. NADPH oxidase inhibition was induced by apocynin (40 mg/kg b.m., intravenously) 5 minutes before reperfusion. AKI significantly increased renal vascular resistance and reduced renal blood flow, which were significantly improved after apocynin treatment. Also, HBO preconditioning, with or without apocynin treatment showed improvement on renal hemodynamics. AKI significantly increased plasma creatinine, urea, phosphate levels and lipid peroxidation in plasma. Remarkable improvement, with decrease in creatinine, urea and phosphate levels was observed in all treated groups. HBO preconditioning, solitary or with apocynin treatment decreased lipid peroxidation in plasma caused by AKI induction. Also, combined with apocynin, it increased catalase activity and solitary, glutathione reductase enzyme activity in erythrocytes. While AKI induction significantly increased plasma KIM- 1 levels, HBO preconditioning, solitary or with apocynin decreased its levels. Considering renal morphology, significant morphological alterations present after AKI induction were significantly improved in all treated groups with reduced tubular dilatation, tubular necrosis in the cortico-medullary zone and PAS positive cast formation. Our results reveal that NADPH oxidase inhibition and hyperbaric oxygen preconditioning, with or without NADPH oxidase inhibition may have beneficial effects, but their protective role should be evaluated in further studies

Hyperbaric Oxygen Preconditioning Upregulates Heme OxyGenase-1 and Anti-Apoptotic Bcl-2 Protein Expression in Spontaneously Hypertensive Rats with Induced Postischemic Acute Kidney Injury

Renal ischemia and reperfusion (I/R) injury is the most common cause of acute kidney injury (AKI). Pathogenesis of postischemic AKI involves hemodynamic changes, oxidative stress, inflammation process, calcium ion overloading, apoptosis and necrosis. Up to date, therapeutic approaches to treat AKI are extremely limited. Thus, the aim of this study was to evaluate the effects of hyperbaric oxygen (HBO) preconditioning on citoprotective enzyme, heme oxygenase-1 (HO-1), pro-apoptotic Bax and anti-apoptotic Bcl-2 proteins expression, in postischemic AKI induced in normotensive Wistar and spontaneously hypertensive rats (SHR). The animals were randomly divided into six experimental groups: SHAM-operated Wistar rats (W-SHAM), Wistar rats with induced postischemic AKI (W-AKI) and Wistar group with HBO preconditioning before AKI induction (W-AKI + HBO). On the other hand, SHR rats were also divided into same three groups: SHR-SHAM, SHR-AKI and SHR-AKI + HBO. We demonstrated that HBO preconditioning upregulated HO-1 and anti-apoptotic Bcl-2 protein expression, in both Wistar and SH rats. In addition, HBO preconditioning improved glomerular filtration rate, supporting by significant increase in creatinine, urea and phosphate clearances in both rat strains. Considering our results, we can also say that even in hypertensive conditions, we can expect protective effects of HBO preconditioning in experimental model of AKI

Challenges and opportunities for ELSI early career researchers

Background: Over the past 25 years, there has been growing recognition of the importance of studying the Ethical, Legal and Social Implications (ELSI) of genetic and genomic research. A large investment into ELSI research from the National Institutes of Health (NIH) Human Genomic Project budget in 1990 stimulated the growth of this emerging field; ELSI research has continued to develop and is starting to emerge as a field in its own right. The evolving subject matter of ELSI research continues to raise new research questions as well as prompt re-evaluation of earlier work and a growing number of scholars working in this area now identify themselves as ELSI scholars rather than with a particular discipline. Main text: Due to the international and interdisciplinary nature of ELSI research, scholars can often find themselves isolated from disciplinary or regionally situated support structures. We conducted a workshop with Early Career Researchers (ECRs) in Oxford, UK, and this paper discusses some of the particular challenges that were highlighted. While ELSI ECRs may face many of the universal challenges faced by ECRs, we argue that a number of challenges are either unique or exacerbated in the case of ELSI ECRs and discuss some of the reasons as to why this may be the case. We identify some of the most pressing issues for ELSI ECRs as: interdisciplinary angst and expertise, isolation from traditional support structures, limited resources and funding opportunities, and uncertainty regarding how research contributions will be measured. We discuss the potential opportunity to use web 2.0 technologies to transform academic support structures and address some of the challenges faced by ELSI ECRs, by helping to facilitate mentoring and support, access to resources and new accreditation metrics. Conclusion: As our field develops it is crucial for the ELSI community to continue looking forward to identify how emerging digital solutions can be used to facilitate the international and interdisciplinary research we perform, and to offer support for those embarking on, progressing through, and transitioning into an ELSI research career.COST Action IS1303Wellcome Trust/096599/2/11/

Applicability of EU(7)-PIM criteria in cross-national studies in European countries

[Abstract] Background: The European Union (EU)(7)-PIM (potentially inappropriate medication) list presents the most comprehensive and up-to-date tool for evaluation of PIM prescribing in Europe; however, several country-specific studies have documented lower specificity of this list on pharmaceutical markets of some countries. The aim of our study was to describe approval rates and marketing of PIMs stated by EU(7)-PIM criteria in six EU countries [in comparison with the American Geriatric Society (AGS) Beers 2015 criteria]. Methods: Research teams of six EU countries (Czech Republic, Spain, Portugal, Serbia, Hungary and Turkey) participated in this study conducted by WG1b EU COST Action IS1402 group in the period October 2015–November 2018. Data on approval rates of PIMs and their availability on pharmaceutical markets have been obtained from databases of national drugregulatory institutes and up-to-date drug compendia. The EU(7)-PIM list and AGS Beers 2015 Criteria (Section 1) were applied. Results: PIMs from EU(7)-PIM list were approved for clinical use more often than those from the AGS Beers 2015 criteria (Section 1). Approval rates for EU(7)-PIMs ranged from 42.8% in Serbia to 71.4% in Spain (for AGS criteria only from 36.4% to 65.1%, respectively). Higher percentages of approved PIMs were documented in Spain (71.4%), Portugal (67.1%) and Turkey (67.5%), lower in Hungary (55.5%), Czech Republic (50.2%) and Serbia (42.8%). The majority of approved PIMs were also currently marketed in all countries except in Turkey (19.8–21.7% not marketed PIMs) and less than 20% of PIMs were available as over-thecounter medications (except in Turkey, 46.4–48.1%). Conclusions: The EU(7)-PIM list was created for utilization in European studies; however, applicability of this list is still limited in some countries, particularly in Eastern and Central Europe. The EU project EUROAGEISM H2020 (2017–2021) that focuses on PIM prescribing and regulatory measures in Central and Eastern European countries must consider these limits.European Commision; project INOMED CZ.02.1.01/0.0/0.0/18_069/001004