31 research outputs found
Large Chondrosarcoma of the Lumbar Spine ā A Rare yet Important Cause of Lower Back Pain
We report a case of a large chondrosarcoma of an L4 vertebral body causing iliac vein thrombosis. The slow-growing tumor eluded definitive diagnosis early in its development since the main symptom it caused was only lower back pain. Five years after onset of the disease, the patient presented with fever, tenderness and swelling in the leg, the tumor was diagnosed and found to be exerting a mass effect causing further pain and compressing the left common iliac vein. Due to inoperability of the tumor, a multidisciplinary surgical approach was used to resect the majority of the tumor as a palliative measure and rid the patient of her symptoms. Due to the chemoresistance and relative radioresistance of these tumors, prompt full surgical resection before the tumor invades vital structures remains the mainstay of successful treatment of chondrosarcoma of the spine
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
Clinical Pharmacist`s Role in Administering Antimicrobial Medicines
Na podruÄju Europske unije godiÅ”nje umire 33 110 ljudi od posljedica infekcija uzrokovanih bakterijama rezistentnima na antibiotike. To je posljedica neadekvatne primjene antibiotika, sve ÄeÅ”Äe nestaÅ”ice lijekova, ali i sporog razvoja novih antibiotika. OÄuvanje uÄinkovitosti antimikrobnih lijekova znaÄajan je javni imperativ, uslijed kojeg se nameÄe potreba za implementacijom programa za antimikrobno upravljanje pomoÄu tima za antimikrobno upravljanje (A-tim).
Znanstveni dokazi upuÄuju na to kako je za uspjeÅ”no provoÄenje programa za antimikrobno upravljanje, uz odgovornost lijeÄnika, neophodna i odgovornost kliniÄkog farmaceuta kao struÄnjaka iz podruÄja lijekova u bilo kojem okruženju. KliniÄki farmaceut, kroz multidisciplinarnu suradnju ā upotrebom svojih farmakoterapijskih znanja i vjeÅ”tina iz podruÄja infektologije ā može znaÄajno doprinijeti smanjenju antimikrobne rezistencije. Nadalje, neophodna je provedba
edukacije iz podruÄja programa za antimikrobno upravljanje i u dodiplomskoj nastavi na farmaceutskim fakultetima u cilju efikasnijeg provoÄenja mjera u borbi protiv AMR u okviru sveuÄiliÅ”nog programa.In European Union 33 110 people die annually as a result of antimicrobial-resistant infections. This is due to an inadequate use of antibiotics, increasingly frequent drug shortages, and slow development of new antibiotics. Preservation of antimicrobial medicines is a significant public imperative imposing a high need for the implementation of antimicrobial medicines administering program by an antimicrobial medicines administering team (A-team). The evidence suggests that for the successful implementation of antimicrobial stewardship program with the responsibility of the physicians, the responsibility of a clinical pharmacist, as a specialist in the field of clinical pharmacy, is also necessary. A clinical pharmacist ā through multidisciplinary collaboration, by using his or her pharmacotherapeutic knowledge and skills ā significantly contributes to the reduction of antimicrobial resistance. Furthermore, the implementation of education
in the field of antimicrobial medicines administering program in postgraduate curriculum at the faculties of pharmacy is necessary in order to have more effective implementation of anti-AMR measures within the university program
Impact of pharmacotherapeutic education on medication adherence and adverse outcomes in patients with type 2 diabetes mellitus: a prospective, randomized study
Aim To evaluate the impact of pharmacotherapeutic education
on 30-day post-discharge medication adherence
and adverse outcomes in patients with type 2 diabetes
mellitus (T2DM).
Methods The prospective, randomized, single-center
study was conducted at the Medical Department of University
Hospital Dubrava, Zagreb, between April and June
2018. One hundred and thirty adult patients with T2DM
who were discharged to the community were randomly
assigned to either the intervention or the control group.
Both groups during the hospital stay received the usual
diabetes education. The intervention group received additional
individual pre-discharge pharmacotherapeutic
education about the discharge prescriptions. Medication
adherence and occurrence of adverse outcomes (adverse
drug reactions, readmission, emergency department visits,
and death) were assessed at the follow-up visit, 30 days after
discharge.Results The number of adherent patients was significantly
higher in the intervention group (57/64 [89.9%] vs 41/61
[67.2%]; Ļ2 test, P = 0.003]. There was no significant difference
between the groups in the number of patients who
experienced adverse outcomes (31/64 [48.4%] vs 36/61
[59.0%]; Ļ2 test, P = 0.236). However, higher frequencies of
all adverse outcomes were consistently observed in the
control group.
Conclusion Pharmacotherapeutic education of patients
with T2DM can significantly improve 30-day post-discharge
medication adherence, without a significant reduction
in adverse clinical outcomes
Primjena smjernica za profilaksu venske tromboembolije u kliniÄkoj praksi: retrospektivno istraživanje u dvjema hrvatskim bolnicama
The aim of this study was to evaluate the implementation of the 9th edition of the American College of Chest Physicians (ACCP9) guidelines for prevention of venous thromboembolism in nonsurgical patients in clinical practice in one university and one general Croatian hospital. A retrospective study was conducted at Zadar General Hospital from Zadar and Dubrava University Hospital from Zagreb. Medical charts of all patients admitted to Medical Departments in two periods, before and after implementation of the ACCP9 guidelines, were analyzed. The ACCP9 guidelines were made available to all physicians through the hospital electronic information system immediately after the publication. The Hospital Drug Committees promoted implementation of the guidelines during their periodical clinical visits. Overall, 850 patients were included in the study in two periods. There was no statistically significant difference in the number of high-risk patients receiving thromboprophylaxis after the guidelines implementation in either hospital. In both periods, a signifi-cantly higher number of high-risk patients received thromboprophylaxis in Dubrava University Hos-pital in comparison with Zadar General Hospital (31.7% vs. 3.8% and 40.3% vs. 7.3%, respectively; p<0.001). This study revealed insufficient implementation of evidence-based thromboprophylaxis guidelines in clinical practice in two Croatian hospitals.Cilj ovoga retrospektivnog istraživanja bio je procijeniti primjenu 9. izdanja smjernica American College of Chest Physicians (ACCP9) za prevenciju venske tromboembolije u nekirurÅ”kih bolesnika u kliniÄkoj i opÄoj bolnici u Republici Hrvatskoj. Istraživanje je provedeno u OpÄoj bolnici Zadar i KliniÄkoj bolnici Dubrava u Zagrebu. Analizirana je medicin-ska dokumentacija svih bolesnika hospitaliziranih na internistiÄke odjele u razdoblju prije i nakon implementacije smjernica ACCP9. Smjernice su bile dostupne svim lijeÄnicima putem bolniÄkih informatiÄkih sustava. BolniÄka povjerenstva za lijekove su Ātijekom periodiÄkih kliniÄkih vizita promovirala primjenu smjernica u kliniÄkoj praksi. U razdoblju prije i nakon implementacije smjernica u istraživanje je ukljuÄeno ukupno 850 bolesnika. Niti u jednoj bolnici nije bilo statistiÄki znaÄajne razlike u broju visoko riziÄnih bolesnika koji su dobili tromboprofilaksu nakon implementacije smjernica. U oba razdoblja je broj Āvisoko riziÄnih bolesnika koji su dobili tromboprofilaksu bio znaÄajno veÄi u KliniÄkoj bolnici Dubrava u odnosu na OpÄu bolnicu Zadar (31,7% prema 3,8% i 40,3% prema 7,3%; p<0,001). Rezultati istraživanja ukazuju na nedostatnu implementaciju smjernica za tromboprofilaksu u dvjema hrvatskim bolnicama
The Relationship between Methylenetetrahydro-folate Reductase C677T Gene Polymorphism and Diabetic Nephropathy in Croatian Type 2 Diabetic Patients
Methylenetetrahydrofolate reductase (MTHFR) polymorphism has been shown to be associated with the development of diabetic nephropathy in many ethnic groups. In this study, we examined the correlation between MTHFR C677T poly- morphism and microalbuminuria in patients with diabetes mellitus type 2 in Croatian patients. 85 patients with diabetes mellitus type 2 were recruited. Patients were classified into two groups ā with and without diabetic nephropathy ac- cording to urinary albumin excretion rate in urine collected during 24 hours. The C677T genotype was determined by real-time PCR analysis. The genotype frequencies were CC 36,5%, CT 42,3% and TT 21,2% in diabetic patients without nephropathy versus CC 39,4%, CT 45,4% and TT 15,2% in those with nephropathy. There was no statistically significant difference in allele distribution between patients with nephropathy and those without (p=0,788). Our study did not show a correlation between mutations in the MTHFR gene and diabetic nephropathy in Croatian patients. Diabetic nephropathy is influenced by multiple risk factors which can modify the importance of MTHFR polymorphism in its de- velopment
Koncentracija bakterija i gljivica u zraku objekta kavezno držanih nesilica.
This paper describes the concentrations of airborne bacteria and fungi in a cage housed laying hens facility, during a production year. Levels of airborne bacteria established in the air of the poultry house ranged from 1.02Ć10 4 CFU/m3 measured in April, to 7.72Ć10 4 CFU/m3 measured in December. Mean values of the total number of fungi ranged from 0.075Ć10 4 CFU/m3 measured in September, to 8.56Ć10 4 CFU/m3 measured in June. Established values of air temperature, relative humidity and air velocity were, generally, in accordance with the technology-predicted ranges. The determined number of bacteria and fungi in the air, as well as the statistically significant impact of microclimate conditions on their number in the air of the cage housed laying hens facility, are in accordance with considerations for standards set for air quality in livestock buildings and the development of reliable systems for monitoring the above factors. The aim is to create production that, besides the economic aspects, must include the protection of animals and people, as well as safety of food and environmenU radu je prikazana koncentracija bakterija i gljivica u zraku objekta kavezno smjeÅ”tenih nesilica tijekom proizvodne godine. Broj bakterija izmjerenih u zraku objekta kretao se od 1,02Ć10 4 CFU/m3, mjereno u travnju, do 7,72Ć10 4 CFU/m3, mjereno u prosincu. Srednje vrijednosti ukupnog broja gljivica iznosile su od 0,075Ć10 4 CFU/m3, izmjerene u rujnu, do 8,56Ć10 4 CFU/m3, izmjereno u lipnju. Izmjerene vrijednosti temperature zraka, relativne vlažnosti i brzine strujanja zraka bile su veÄinom u tehnologijom predviÄenim rasponima. UtvrÄeni broj bakterija i gljivica u zraku, kao i statistiÄki znaÄajan utjecaj mikroklimatskih uvjeta na njihov broj u zraku objekta kavezno držanih nesilica, ukazuju na potrebu za postavljanjem standarda o kakvoÄi zraka u nastambama za životinje te razvoj pouzdanog sustava za praÄenje navedenih Äimbenika. Cilj je stvoriti proizvodnju koja, osim zadovoljenja ekonomskih Äimbenika, mora sadržavati i zaÅ”titu životinja i ljudi, kao i sigurnost hrane i okoliÅ”a
The effectiveness of lixisenatide as an add on therapy to basal insulin in diabetic type 2 patients previously treated with different insulin regimes: a multi -center observational study
Introduction:
This observational study aimed to assess the effectiveness of lixisenatide as add on therapy to basal
insulin in diabetic type 2 patients previously treated with different insulin regimes.
Methods:
Patients with diabetes type 2, prescribed with lixisenatide and basal insulin were divided in three groups
(premixed insulin, basal bolus insulin and basal oral therapy (BOT ). Difference in mean change in HbA1c, body
mass index, total insulin doses, fasting blood glucose (FPG) and prandial blood glucose (PPG) were assessed after
3ā6
āmonths of follow
āup.
Results:
The primary outcomes were assessed in 111 patients. Lixisenatide added to basal insulin, reduced HbA1c
and body weight significantly in all three groups of patients (p
< 0.001 for all), with the most prominent reduction
in the basal bolus group of patients which had the highest baseline HbA1c compared to premix and BOT treat
ā
ment groups. Regarding a difference in total insulin dose the reduction was statistically significant in the basal bolus
(p
=
0.006) and premix group (p
< 0.001). FPG and PPG were also significantly reduced over time in all three groups
(p < 0.001 for all). A composite outcome (reduction of HbA1c below 7% (53
mmol/mol) with any weight loss) was
achieved in 27% of total patients included in the study, reduction of HbA1c below 7% was observed in 30% of
patients, while 90% of patients experienced weight reduction.
Conclusion:
These results indicate that lixisenatide add on basal insulin treatment (BIT ) can improve glycemic conā
trol in a population with long
āstanding type 2 diabetes and previously uncontrolled on other insulin therap