8 research outputs found
Exacerbation of Chronic Obstructive Pulmonary Disease: A Role of Antibiotics?
In order to discuss a role of antibiotics, a 73-year old patient was presented, having an exacerbation of Chronic Obstructive
Pulmonary Disease (COPD) and to whom amoxicillin/clavulanate antibiotic was prescribed. Literature search
has indicated that antibiotics are recommended for COPD patients in two cases. Firstly, they are recommended in the patients
having an acute exacerbation with increased dyspnoea, sputum volume, and sputum purulence. Common options
usually include amoxicillin, amoxicillin/clavulanate, azithromycin, and doxycycline. Secondly, it is also recommended
for preventive purposes in patients with severe COPD having frequent exacerbations. But, still remain uncertainty on the
antibiotic used in outpatients, having mild or moderate COPD
A Role of Family Doctors in Taking Care of Menās Health
The aim of this study was to investigate, based on routinely collected data, the scope of family doctors work in the field
of menās health. Based on the Croatian Health Service Yearbook in the period from 1995 to 2012, we collected the morbidity
data related to male urogenital disorders. The total number of urogenital disorders almost doubled, but the number of
diagnoses related to the men increased fourfold, mostly among the oldest patients. The number of prostate hyperplasia
increased fivefold, again among the oldest people. The morbidity from other male-specific diseases increased threefold,
mostly in the age group 7ā19 years. In spite of the increase in the number of newly diagnosed cases of prostate cancer, the
percentage of the deaths stabilized after 2001. Menās health problems are frequent sees and with an upward trend.We are
not sure if this means deterioration of menās health, or just indicates the problem of Ā»overdiagnosisĀ«
FAMILY AS THE FUNDAMENTAL CORE OF PALLIATIVE CARE - CASE REPORT
Velika veÄina oboljelih koji se nalaze u terminalnoj fazi bolesti žele skrb i mjesto umiranja u svojem domu, u svojoj poznatoj sredini, uz svoju obitelj. Za bolesnika to Äesto znaÄi smanjenje straha od
samoÄe, veÄi osjeÄaj sigurnosti i poboljÅ”anje dijela simptoma u obiteljskom okruženju. NajveÄi teret u provoÄenju palijativne skrbi u domu bolesnika podnosi najoptereÄeniji Älan obitelji, kljuÄni Älan, a to je njegov njegovatelj. On mora biti u uskoj suradnji sa svojim obiteljskim lijeÄnikom i obavjeÅ”tavati ga o svim nastupajuÄim promjenama kod oboljelog. Obiteljski lijeÄnik Äe po potrebi organizirati u okviru svojih moguÄnosti pomoÄ i konzultacije na horizontalnom i vertikalnom nivou, od kuÄne njege, fizikalne terapije, patronažne službe, sanitetskog prijevoza, usluge vaÄenja uzoraka u
kuÄi za laboratorijske analize, primanja parenteralne terapije, konzultacije sa specijalistiÄkom službom, psiholoÅ”ku pomoÄ i sl., a kroz kuÄne posjete svoga tima rjeÅ”avati akutno nastale zdravstvene.
poremeÄaje. Ali je odgovornost i na cijelom druÅ”tvu i zdravstvenom sustavu u organiziranju pomoÄi kako oboljelome tako i obitelji u razdoblju kad se bolest viÅ”e ne može aktivno lijeÄiti i kad je nužna
trajna potporna i palijativna skrb. Svakodnevna i dugotrajna njega bolesnog ukuÄana može biti izuzetno psihiÄki i fiziÄki naporna za kljuÄnog Älana obitelji, jer duljina života u terminalnoj fazi je nepredvidiva. Balansiranje izmeÄu vlastitih potreba, potreba bolesnika i ostalih Älanova obitelji može kod njegovatelja dovesti
do premorenosti i sindroma iscrpljenja. LijeÄnik mora prepoznati znakove premorenosti kljuÄne osobe i na vrijeme joj osigurati pomoÄ i potporu. Najvažnije je da i pacijent i njegova obitelj znaju da od njih lijeÄnici obiteljske medicine i njihovi suradnici nisu ādigli rukeā, veÄ da Äe biti uz njih sve preostalo vrijeme koje budu proveli zajedno sa
svojim umiruÄim Älanom obitelji. U ovom radu prikazali smo palijativnu skrb, teÅ”ko oboljelog pacijenta s multifunkcijskim oÅ”teÄenjima nakon cerebrovaskularnog inzulta koja je organizirana i provoÄena u domu bolesnika. Uz zdravstvenu, psiholoÅ”ku i duhovnu pomoÄ oboljelome i njegovoj obitelji, uz permanentnu skrb kljuÄne osobe, supruge oboljelog, pacijent je proživio 2,3 g u obiteljskom okruženju i umro po želji obitelji uz svoje najbliže. Pred lijeÄnika
obiteljske medicine uvijek se nakon smrti bolesnika postavlja pitanje āDa li se možda moglo i viÅ”e pomoÄi?āThe vast majority of terminally ill patients want care and the dying in their homes, in their familiar surroundings, with her family. For patients, this often means a reduction in the fear of being alone, a greater sense of security and improvement of the
symptoms. The greatest burden in implementing palliative care in the home of patients submitted overloaded family member, a key member, and this is his carer. He must be in close cooperation with your family doctor and inform him about any upcoming changes
sufferer. Family physician if necessary to organize within their capabilities help and consultation on horizontal and vertical level of home care, physical therapy, home care services, medical transport
services, removing samples at home to laboratory analyses, receiving parenteral therapy, consultations with specialist services, psychological assistance, etc., and through home visits your team solve acute acquired health. disorders. But the responsibility is
on the whole society and the health care system in the organization to help oboljelome and families in those hardest. Daily and long-term care ill inmates can be extremely mentally and physically exhausting for a key member of the family, because the length of life in the terminal phase is unpredictable. Balance between their own needs, the needs of the patient and other family members can lead to the caregiver exhaustion. The physician must recognize the signs of fatigue and the key people at a time to provide her help and support. Most important is that the patient and his family know that one of them did not āgiven upā, but that will be with them all the
time remaining to be spent together. In this paper, we show palliative care in their own home, seriously ill patients with multifunction
impairments after stroke. In addition to medical, psychological and spiritual help oboljelome and his family, and the permanent care key persons, wife ill, the patient survived 2.3 g in a family environment,
and died at the familyās wishes with your loved ones. Would you perhaps be more family help
FAMILY AS THE FUNDAMENTAL CORE OF PALLIATIVE CARE - CASE REPORT
Velika veÄina oboljelih koji se nalaze u terminalnoj fazi bolesti žele skrb i mjesto umiranja u svojem domu, u svojoj poznatoj sredini, uz svoju obitelj. Za bolesnika to Äesto znaÄi smanjenje straha od
samoÄe, veÄi osjeÄaj sigurnosti i poboljÅ”anje dijela simptoma u obiteljskom okruženju. NajveÄi teret u provoÄenju palijativne skrbi u domu bolesnika podnosi najoptereÄeniji Älan obitelji, kljuÄni Älan, a to je njegov njegovatelj. On mora biti u uskoj suradnji sa svojim obiteljskim lijeÄnikom i obavjeÅ”tavati ga o svim nastupajuÄim promjenama kod oboljelog. Obiteljski lijeÄnik Äe po potrebi organizirati u okviru svojih moguÄnosti pomoÄ i konzultacije na horizontalnom i vertikalnom nivou, od kuÄne njege, fizikalne terapije, patronažne službe, sanitetskog prijevoza, usluge vaÄenja uzoraka u
kuÄi za laboratorijske analize, primanja parenteralne terapije, konzultacije sa specijalistiÄkom službom, psiholoÅ”ku pomoÄ i sl., a kroz kuÄne posjete svoga tima rjeÅ”avati akutno nastale zdravstvene.
poremeÄaje. Ali je odgovornost i na cijelom druÅ”tvu i zdravstvenom sustavu u organiziranju pomoÄi kako oboljelome tako i obitelji u razdoblju kad se bolest viÅ”e ne može aktivno lijeÄiti i kad je nužna
trajna potporna i palijativna skrb. Svakodnevna i dugotrajna njega bolesnog ukuÄana može biti izuzetno psihiÄki i fiziÄki naporna za kljuÄnog Älana obitelji, jer duljina života u terminalnoj fazi je nepredvidiva. Balansiranje izmeÄu vlastitih potreba, potreba bolesnika i ostalih Älanova obitelji može kod njegovatelja dovesti
do premorenosti i sindroma iscrpljenja. LijeÄnik mora prepoznati znakove premorenosti kljuÄne osobe i na vrijeme joj osigurati pomoÄ i potporu. Najvažnije je da i pacijent i njegova obitelj znaju da od njih lijeÄnici obiteljske medicine i njihovi suradnici nisu ādigli rukeā, veÄ da Äe biti uz njih sve preostalo vrijeme koje budu proveli zajedno sa
svojim umiruÄim Älanom obitelji. U ovom radu prikazali smo palijativnu skrb, teÅ”ko oboljelog pacijenta s multifunkcijskim oÅ”teÄenjima nakon cerebrovaskularnog inzulta koja je organizirana i provoÄena u domu bolesnika. Uz zdravstvenu, psiholoÅ”ku i duhovnu pomoÄ oboljelome i njegovoj obitelji, uz permanentnu skrb kljuÄne osobe, supruge oboljelog, pacijent je proživio 2,3 g u obiteljskom okruženju i umro po želji obitelji uz svoje najbliže. Pred lijeÄnika
obiteljske medicine uvijek se nakon smrti bolesnika postavlja pitanje āDa li se možda moglo i viÅ”e pomoÄi?āThe vast majority of terminally ill patients want care and the dying in their homes, in their familiar surroundings, with her family. For patients, this often means a reduction in the fear of being alone, a greater sense of security and improvement of the
symptoms. The greatest burden in implementing palliative care in the home of patients submitted overloaded family member, a key member, and this is his carer. He must be in close cooperation with your family doctor and inform him about any upcoming changes
sufferer. Family physician if necessary to organize within their capabilities help and consultation on horizontal and vertical level of home care, physical therapy, home care services, medical transport
services, removing samples at home to laboratory analyses, receiving parenteral therapy, consultations with specialist services, psychological assistance, etc., and through home visits your team solve acute acquired health. disorders. But the responsibility is
on the whole society and the health care system in the organization to help oboljelome and families in those hardest. Daily and long-term care ill inmates can be extremely mentally and physically exhausting for a key member of the family, because the length of life in the terminal phase is unpredictable. Balance between their own needs, the needs of the patient and other family members can lead to the caregiver exhaustion. The physician must recognize the signs of fatigue and the key people at a time to provide her help and support. Most important is that the patient and his family know that one of them did not āgiven upā, but that will be with them all the
time remaining to be spent together. In this paper, we show palliative care in their own home, seriously ill patients with multifunction
impairments after stroke. In addition to medical, psychological and spiritual help oboljelome and his family, and the permanent care key persons, wife ill, the patient survived 2.3 g in a family environment,
and died at the familyās wishes with your loved ones. Would you perhaps be more family help
ALCOHOLISM ā FORGOTTEN DIAGNOSIS IN FAMILY PRACTICE
Cilj rada je utvrÄivanje kretanja dijagnoza alkoholizma registriranih u ordinacijama OM u razdoblju od 1995. do 2012. godine. Iz Hrvatsko
zdravstveno - statistiÄkih ljetopisa analizirali smo pobol od duÅ”evnih bolesti (F dijagnoze) registriran u obiteljskoj medicini, s posebnim osvrtom na podgrupu bolesti vezanih za alkoholizam (F 10).
Rezultati istraživanja ukazuju da, paralelno s porastom ukupnog pobola u obiteljskoj medicini, raste i pobol od duÅ”evnih bolesti. Porast pobola je uoÄen u svim grupama duÅ”evnih bolesti, osim kod duÅ”evnih
bolesti vezanih uz alkoholizam. U 1998. godini alkoholizam je sudjelovao s 9% u ukupnom pobolu od duÅ”evnih bolesti, a u 2012. samo s 3,2%. Pad broja registriranih dijagnoza alkoholizma je uoÄen
u svim dobnim grupama. NajveÄi je pad u grupi 7 - 19 godina, za 66,9%, zatim u starijih od 65 godina, za 33,6%, a najmanji u grupi 20 - 64 godine, za 20,5%. GledajuÄi apsolutne brojeve, samo je 21077
oboljelih od alkoholizma registrirano u obiteljskoj medicini u 2012. ili samo 0,6% odrasle populacije.
UtvrÄeno je znatno manje registriranih dijagnoza povezanih uz uzimanje alkohola, s kontinuiranim opadanjem u 18 - godiÅ”njem razdoblju. Razloge āzanemarivanjaā ovih dijagnoza u OM trebalo bi
dodatno istražiti jer su ta stanja ne samo ozbiljan medicinski nego i socijalno - ekonomski problem.The aim of this study was to estimate trends of diagnosed alcoholism registered in general practice offices from 1995 to 2012. Mental health diseases (F)morbidity registered in family medicine was analysed from data published in the Croatian Health Service Yearbooks, with special emphasis on subgroup of disorders due to use of alcohol (F10).
Results of our study show that together with the increase of the total number of diseases in family medicine the number of mental diseases increase as well. The increase was noticed in all groups of mental diseases except in the group of mental diseases due to use of alcoholism. Alcoholism participated 9% in 1998 and only 3.2% in 2012 in total number of mental diseases. Decrease in the number of registered diagnosis of alcoholism was noticed in all age groups. It was the highest in the age group 7-19 years of age (66.9%), followed by those over 65 years (33.6%). It was the lowest in the group
aged 20-64 years (20.5%). Taking into consideration the absolute numbers, only 21.077 alcoholic patients were registered in family medicine in 2012 or only 0.6% of the adult population.Significantly smaller number of registered diagnosis connected to alcohol drinking than expected was established and it was deceasing with continuity during the 18 years period. Reasons for Ā«neglectingĀ» this diagnosis in family medicine should be examined because alcoholism is very
serious medical and socio-economic problem
Nine-year Trends in the Morbidity of Mental Disorders and Psychotropic Drug Utilization in Croatia: Over-diagnosis and Over-utilization?
Overall drug overuse, including psychotropic, is the Croatian reality. Therefore, in between 2000 and 2012, the interventions
to control drug overspending were undertaken. The main aims of the study are: to determine the morbidity
trends of mental disorders registered in family medicine (FM), the trends in psychotropic drug utilization and to identify
whether the trends of utilization have any relation to the interventions. The results indicate that mental disorders represent
a high disease burden in Croatia. It was also present a higher burden of psychotropic drug utilization; second
ranked in the total drug utilization during the nine-year follow up period. The utilization of psycholepticās, was even
higher; from 2004 to 2008; those drugs were ranked first in terms of utilization. Between 20ā25% of Croatiaās total
health care budget is usually spent on drugs. The interventions that are currently being implemented to control drug utilization
have not brought about any changes
ZaÅ”to oportunistiÄki probir za preddijabetes i Å”eÄernu bolest u obiteljskoj medicini? Proces probira traži prilagodbe
Procijenjeno je da je jedna treÄina do jedne polovine osoba sa Å”eÄernom bolesti neotkriveno i stoga nelijeÄeno. SZO preporuÄa Ā prevenciju i rano otkrivanje bolesti kao važan segment u zaustavljanju epidemijske pojavnosti bolesti. OportunistiÄki probir na neotkrivenu bolest u ordinacijama obiteljske medicine najprihvatljivija je metoda. Proces se odvija na temelju jedinstva: Äimbenika rizika (poznavanja pacijenta i obitelji), prostora u kojem se proces odvija, postupaka intervencije nakon probiranja, lijeÄenja i praÄenja pacijenta nakon intervencije. Obiteljskom lijeÄniku potreban je jednostavan postupak koji Äe provoditi tim obiteljskog lijeÄnika u vremenskim i prostornim kapacitetima prakse koji neÄe dodatno opteretiti konzultaciju, pacijenta i zdravstveni sustav. Takav postupak može postati rutinski rad lijeÄnika obiteljske medicine. U radu je prikazan model za poboljÅ”anje prikupljanja podataka o rizicima iz elektronske medicinske dokumentacije prema WONCA International Classiffication Commitee (WICC)
ZaÅ”to oportunistiÄki probir za preddijabetes i Å”eÄernu bolest u obiteljskoj medicini? Proces probira traži prilagodbe
Procijenjeno je da je jedna treÄina do jedne polovine osoba sa Å”eÄernom bolesti neotkriveno i stoga nelijeÄeno. SZO preporuÄa Ā prevenciju i rano otkrivanje bolesti kao važan segment u zaustavljanju epidemijske pojavnosti bolesti. OportunistiÄki probir na neotkrivenu bolest u ordinacijama obiteljske medicine najprihvatljivija je metoda. Proces se odvija na temelju jedinstva: Äimbenika rizika (poznavanja pacijenta i obitelji), prostora u kojem se proces odvija, postupaka intervencije nakon probiranja, lijeÄenja i praÄenja pacijenta nakon intervencije. Obiteljskom lijeÄniku potreban je jednostavan postupak koji Äe provoditi tim obiteljskog lijeÄnika u vremenskim i prostornim kapacitetima prakse koji neÄe dodatno opteretiti konzultaciju, pacijenta i zdravstveni sustav. Takav postupak može postati rutinski rad lijeÄnika obiteljske medicine. U radu je prikazan model za poboljÅ”anje prikupljanja podataka o rizicima iz elektronske medicinske dokumentacije prema WONCA International Classiffication Commitee (WICC)