Opportunities for use of blockchain technology in medicine

Blockchain technology is a decentralized database that stores a registry of assets and transactions across a peer-to-peer computer network, which is secured through cryptography, and over time, its history gets locked in blocks of data that are cryptographically linked together and secured. So far, there have been use cases of this technology for cryptocurrencies, digital contracts, financial and public records, and property ownership. It is expected that future uses will expand into medicine, science, education, intellectual property, and supply chain management. Likely applications in the field of medicine could include electronic health records, health insurance, biomedical research, drug supply and procurement processes, and medical education. Utilization of blockchain is not without its weaknesses and currently, this technology is extremely immature and lacks public or even expert knowledge, making it hard to have a clear strategic vision of its true future potential. Presently, there are issues with scalability, security of smart contracts, and user adoption. Nevertheless, with capital investments into blockchain technology projected to reach US$400 million in 2019, health professionals and decision makers should be aware of the transformative potential that blockchain technology offers for healthcare organizations and medical practice

PATHOPHYSIOLOGY OF ALLERGIC DRUG REACTIONS

Adverse drug reactions (ADR) may be broadly divided into types A and B. Type A comprise the majority of reactions, can affect any individual, and are predictable from the known pharmacologic properties of a drug. Type B are less common, occur in susceptible patients and cannot be predicted. Allergic/immunologic drug reactions are a group of type B ADRs. Based on the time of onset allergic drug reactions can be divided into immediate and delayed and based on their underlaying immunologic mechanism, they can be further subdivided into 4 groups: immediate and mediated by IgE (1), delayed and caused by antibody facilitated cell destruction (2), delayed and caused by drug immune complex deposition and complement activation (3) and delayed and T cell mediated (4). Physicians should always insist on obtaining a thorough patient’s history regarding drug allergy as well as on ascertaining details regarding the medication used, its route of administration, dosage and the treatment duration in order to properly assess risk of drug allergies and suggest further work-up in that regard

PATHOPHYSIOLOGY OF ALLERGIC DRUG REACTIONS

Adverse drug reactions (ADR) may be broadly divided into types A and B. Type A comprise the majority of reactions, can affect any individual, and are predictable from the known pharmacologic properties of a drug. Type B are less common, occur in susceptible patients and cannot be predicted. Allergic/immunologic drug reactions are a group of type B ADRs. Based on the time of onset allergic drug reactions can be divided into immediate and delayed and based on their underlaying immunologic mechanism, they can be further subdivided into 4 groups: immediate and mediated by IgE (1), delayed and caused by antibody facilitated cell destruction (2), delayed and caused by drug immune complex deposition and complement activation (3) and delayed and T cell mediated (4). Physicians should always insist on obtaining a thorough patient’s history regarding drug allergy as well as on ascertaining details regarding the medication used, its route of administration, dosage and the treatment duration in order to properly assess risk of drug allergies and suggest further work-up in that regard

Satisfaction and attitudes of Zagreb medical students towards online education during the COVID-19 pandemic

In March 2020 all in-person teaching activities at the University of Zagreb School of Medicine ceased due to COVID-19 pandemic and online classes were introduced till the end of the academic year. Both teachers and students experienced a completely new teaching environment

Brain drain: final year medical students' intentions of training abroad

BACKGROUND: In Croatia, a new European Union (EU) member state since July 2013, there is already a shortage of around 3280 doctors to reach the European average. ----- OBJECTIVES: To investigate the emigration intentions of the current cohort of final year medical students at Zabreb School of Medicine. ----- METHODS: An electronic questionnaire was used in June 2013 to assess the attitudes of 232 final year medical students towards working conditions abroad and expectations for career opportunities in Croatia following accession to the EU. ----- RESULTS: With an overall response rate of 87%, more than half of the surveyed students (106/202, 53%) intended to travel abroad, either for specialty (52/202, 26%) or subspecialty (54/202, 27%) training. More female students (58/135, 43%) than male students (17/62, 27%) indicated they would not emigrate. Most attractive emigration destinations were: Germany (34/121, 28%), USA (19/121, 16%), the UK (19/121, 16%), Switzerland (16/121, 13%) and Canada (11/121, 9%). The most important goals that respondents aimed to achieve through training abroad were to excel professionally (45/120, 38%), to prosper financially (20/120, 17%) and to acquire new experiences and international exposure (31/120, 26%). ----- CONCLUSIONS: Students' motivating factors, goals for and positive beliefs about training abroad, as well as negative expectations regarding career opportunities in Croatia, may point towards actions that could be taken to help make Croatia a country that facilitates medical education and professional career development of young doctors

Distributed lags time series analysis versus linear correlation analysis (Pearson's r) in identifying the relationship between antipseudomonal antibiotic consumption and the susceptibility of Pseudomonas aeruginosa isolates in a single Intensive Care Unit of a tertiary hospital

The relationship between antibiotic consumption and selection of resistant strains has been studied mainly by employing conventional statistical methods. A time delay in effect must be anticipated and this has rarely been taken into account in previous studies. Therefore, distributed lags time series analysis and simple linear correlation were compared in their ability to evaluate this relationship. Data on monthly antibiotic consumption for ciprofloxacin, piperacillin/tazobactam, carbapenems and cefepime as well as Pseudomonas aeruginosa susceptibility were retrospectively collected for the period April 2006 to July 2007. Using distributed lags analysis, a significant temporal relationship was identified between ciprofloxacin, meropenem and cefepime consumption and the resistance rates of P. aeruginosa isolates to these antibiotics. This effect was lagged for ciprofloxacin and cefepime [1 month (R=0.827, P=0.039) and 2 months (R=0.962, P=0.001), respectively] and was simultaneous for meropenem (lag 0, R=0.876, P=0.002). Furthermore, a significant concomitant effect of meropenem consumption on the appearance of multidrug-resistant P. aeruginosa strains (resistant to three or more representatives of classes of antibiotics) was identified (lag 0, R=0.992, P<0.001). This effect was not delayed and it was therefore identified both by distributed lags analysis and the Pearson's correlation coefficient. Correlation coefficient analysis was not able to identify relationships between antibiotic consumption and bacterial resistance when the effect was delayed. These results indicate that the use of diverse statistical methods can yield significantly different results, thus leading to the introduction of possibly inappropriate infection control measures

Mogućnosti upotrebe blockchain tehnologije u medicini

Blockchain tehnologija decentralizirana je baza podataka koja pohranjuje registar vlasništva i transakcija preko računalne mreže ravnopravnih računala, koja je osigurana kriptografijom, a tijekom vremena njena se povijest zaključava u blokove podataka koji su kriptografski povezani i osigurani. Do sada se primjeri upotrebe ove tehnologije susreću primarno u transakcijama kriptovalutama, digitalnim ugovorima, financijskim i javnim zapisima te vlasništvu nad nekretninama. Očekuje se da će se u budućnosti upotreba proširiti u medicinu, znanost, obrazovanje, intelektualno vlasništvo i upravljanje lancem opskrbe. Vjerojatna primjena u području medicine mogla bi uključivati elektroničke zdravstvene zapise, zdravstveno osiguranje, biomedicinska istraživanja, opskrbu i nabavu lijekova te medicinsko obrazovanje. Korištenje blockchaina nije bez slabosti i trenutno je ova tehnologija iznimno nezrela te joj nedostaje upoznatost javnosti, ali čak i stručno znanje, što otežava jasnu stratešku viziju pravog budućeg potencijala. Trenutno postoje problemi s količinom podataka u sustavu, sigurnošću pametnih ugovora i usvajanjem tehnologije od strane korisnika. Ipak, s ulaganjima u blockchain tehnologiju koja bi trebala doseći 400 milijuna USD u 2019. godini, zdravstveni stručnjaci i donositelji odluka trebali bi biti svjesni transformirajućeg potencijala koji blockchain tehnologija nudi zdravstvenim organizacijama i medicinskoj praksi