Digitalne zdravstvene tehnologije (engl. Digital Health Technologies, DHT) uključuju širok raspon različitih proizvoda koji se koriste u sustavu zdravstvene i socijalne skrbi (aplikacije, softveri i ...online platforme), a mogu biti namijenjeni dobrobiti pojedinca ili sustava zdravstvene i socijalne skrbi. Budući da su digitalne intervencije postale sastavni dio skrbi o pacijentima nametnula se potreba za njihovom kliničkom validacijom i propisanom regulacijom unutar zdravstvenih sustava. Unatoč sve bržim naporima usmjerenim na digitalnu transformaciju u zdravstvu velik je izazov proizvesti čvrste dokaze za većinu digitalnih zdravstvenih rješenja na pravodoban i troškovno učinkovit način, pa za mnoga digitalna rješenja koja se primjenjuju dokazi o koristi tih alata ne postoje ili nisu javno prezentirani. Uzimajući u obzir složenost zdravstvenih sustava, cijenu i trajanje tradicionalnih pristupa za osiguravanje dokaza učinkovitosti medicinskih proizvoda (u koje spada i dio digitalnih zdravstvenih aplikacija)
potrebno je zajednički poraditi na metodama i alatima koji su prihvatljivi inovatorima i svim ostalim dionicima u zdravstvenom sustavu te osigurati materijalna sredstva i ostale resurse potrebne za sagledavanje svih aspekata nužnih za učinkovitu i sigurnu implementaciju digitalnih zdravstvenih tehnologija.
The objective of this study was to evaluate the impact of comprehensive medication management (CMM) services on healthcare utilisation and cardiovascular risk factors among older patients with ...established cardiovascular diseases (CVDs). This quasi-experimental study that was performed at the Croatian primary care ambulatory clinic included patients aged 65 to 80 years. Patients were divided into intervention (65 patients) and control groups (68 patients) and were followed-up for one year. Pharmacists provided face-to-face consultations to patients from the intervention group. Groups were compared with regards to the clinical parameters (blood pressure, HbA1c, LDL, TC) and healthcare utilisation (hospital admission, emergency visits, unplanned GP visits). The CMM intervention significantly improved systolic blood pressure (p = 0.038), diastolic blood pressure (p = 0.001), total cholesterol (p = 0.014), low-density lipoprotein cholesterol (p = 0.005), and glycosylated haemoglobin (p = 0.045) in comparison with the control group. Patients included in CMM services had statistically and clinically lower systolic (−9.02 mmHg, p < 0.001) and diastolic blood pressure (−4.99 mmHg, p < 0.001) at the end of the study. The number of hospital admissions and unplanned GPs visits were 3.35 (95% CI 1.16−10.00) and 2.34 (95% CI 1.52−3.57) times higher in the control group compared to the intervention group, respectively. This study demonstrated that pharmacists providing CMM services can significantly contribute to better clinical outcomes and lower healthcare utilisation, thus potentially contributing to total healthcare savings.
This study employed a mixed-method approach to enable the implementation of comprehensive medication management (CMM) services in Croatia’s primary care setting. Drug therapy problems (DTPs) and ...factors associated with their occurrence were determined in patients with chronic diseases from January 2018 to April 2019. The pre-implementation stage established the foundations for the early implementation stage, in which the practice was set up, the patients’ recruitment initiated and various challenges identified. During the study period, 86 patients were recruited for CMM provision. Overall, 2.8 DTPs (± 1.6) per patient were identified and the majority (96.2 %) presented with at least one DTP. Multiple regression analysis showed that type 2 diabetic patients (
= 0.025) and patients using five or more medications (
= 0.011) should be prioritized to receive CMM services as potentially they have a higher number of DTPs, and could, therefore, obtain a greater benefit from the service.
The objective of the study was to determine the sociodemographic and clinical parameters of patients who visit the emergency dental service and their most common diagnoses.
The data were collected on ...the basis of a survey filled out by patients. A total of 1730 out of 6732 patients (26%) were surveyed using a questionnaire to analyze sociodemographic status, dental visits, the description and dynamics of the symptoms. After the data collection, methods of descriptive data presentation and of inferential statistics were made in SPSS.
Survey results show that most subjects (60.4%) came during the weekends and holidays. The subjects, 73.1% of them, stated that they had already used this type of service, and 65.8% did not visit their dentist beforehand. The largest number of subjects (62.2%) reported that they needed emergency service within a week after their problems had begun. The most common diagnoses included face and jaw abscesses (27.3%). There is a statistically significant difference between the number of patients who went to the emergency dental service and completed the questionnaire over the course of several months contrary to patients who were there in May and June (59.7%) compared to July and August (40.3%).
Most subjects had clear indications for being referred to an emergency dental service. Most of the emergency conditions were mainly due to irregular visits to the dentist. Patient education and preventive programs would probably have reduced the number of visits.
PET/CT is starting to play an important role in evaluating fever of unknown origin (FUO), due to its ability to localize and delineate areas of high metabolic activity, such as neoplastic ...proliferation and inflammation, including vasculitis. We present a case of giant cell arteritis (GCA) in a 72-year-old female patient admitted to our department with a 4-month history of FUO, weight loss and fatigue, without specific symptoms or signs. Laboratory investigations suggested acute phase response, with a pronounced erythrocyte sedimentation rate, high CRP level and microcytic anemia. A thorough diagnostic evaluation was performed to exclude an unknown primary tumor, which was initially suspected due to a positive family history of cancer. Surprisingly, PET/CT revealed large vessel vasculitis affecting the ascending, descending and abdominal aorta, as well as subclavian, proximal brachial and carotid arteries bilaterally. Biopsy of the superficial temporal artery confirmed the diagnosis of GCA. Treatment with methylprednisolone and azathioprine led to resolution of clinical symptoms and normalization of laboratory parameters. In addition to the use of PET/CT in the evaluation of FUO, its value as a method complementary to temporal artery biopsy is also discussed.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
In ankylosing spondylitis, inflammatory activity probably plays a key role in the pathophysiology of bone loss. The aim of the study was to investigate the relationship of bone mineral density (BMD) ...at the lumbar spine and hip region with some measures of disease activity and functional ability in patients with ankylosing spondylitis. In 80 patients with established ankylosing spondylitis, disease activity and functional ability were determined by C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Bath Ankylosing Spondylitis Functional Index (BASFI). Spinal pain and patient global health were assessed using horizontal visual analog scale. BMD was measured by dual-energy X-ray absorptiometry. There was a significant negative correlation of bone density T scores with acute-phase reactants (i.e., patients with lower T scores had higher level of CRP and ESR). That relationship was reflected more reliably at proximal femur sites than at the lumbar spine. There were also significant differences in ESR, BASDAI, BASFI, spinal pain and global health between three groups of patients according to WHO classification of osteoporosis (normal, osteopenic and osteoporotic). Significantly, more patients with osteopenia at the lumbar spine had lower BASDAI index than those with normal BMD (
P
= 0.030). Our results indicate an association of low BMD with high disease activity in patients with AS. Femoral BMD seems to be more associated with disease activity and functional ability than lumbar spine BMD.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Medical emergencies that are life threatening can occur in dental practice. Complications may arise because of an underlying disease or a reaction to medication. Reactions to medications may be ...allergic and toxic. The most common reactions are toxic reactions to local anesthetics, whereas allergies occur mainly as a consequence of the application of antibiotics, usually penicillin. In response to stress, vasovagal syncope typically occurs. Other causes may be related to an underlying disease-specific pathology (such as acute asthma attack, diabetic ketoacidosis, hypoglycemia, or seizures) or accidents (aspiration of a foreign body causing obstruction of the respiratory system). For all the above conditions, guidelines have been established that need to be known. If complications occur or necessary measures are not taken, it can lead to cardiac and respiratory arrest. Therefore, cardiopulmonary resuscitation is needed. All procedures and dosages should be adapted to the age of the child.
Slikovne metode u onkologiji omogućile su ranije dijagnosticiranje malignih oboljenja, brižljivije praćenje tijeka bolesti i ranije otkrivanje lokalnog recidiva ili diseminacije bolesti te bitno ...pridonijele činjenici da se danas karcinom smatra kroničnom bolesti. Slikovne metode dijelimo na one kojima prikazujemo morfologiju organa i tkiva i one kojima prikazujemo funkciju, odnosno metabolizam organa i tkiva. Prije odluke o odabiru slikovne metode nužno je postaviti kliničko pitanje i cilj koji želimo postići određenom pretragom. Također je važno slijediti i dijagnostičke algoritme u postavljanju indikacije za slikovne pretrage. Problem s kojim se susreću liječnici opće medicine je i moguća štetnost od (pre)čestih snimanja.
Lymphoproliferative diseases include a wide range of malignant diseases with
various histological characteristics, clinical presentation and therapeutic
possibilities. Reliable assessment of the ...spread of the disease and the
knowledge of the biological characteristics of the tumor are the
prerequisites of a successful patient treatment. In most patients with
lymphoma, positron emission tomography (PET) with fluorodeoxyglucose ( 18
F-FDG) proved to be a useful imaging method which contributes to the
assessment of the spread of the disease by identifying increased glycolysis
in tumor cells. In the initial phases of the clinical implementation of FDG
PET, the method was mostly used to determine the stage of the disease. At
present, FDG PET is being increasingly used to assess the effects of therapy
and to determine prognostic factor. Today, the treatment of lymphoma patients
implies an individualized approach aiming at maximum disease control with the
smallest possible risk of late side effects. Numerous prospective studies in
patients with lymphoma have contributed to a better understanding of the
metabolic changes. FDG PET performed after only 1 or 2 cycles of chemotherapy
can assess tumor sensitivity to the therapy. Thus, the long-term response to
therapy can be predicted at the very early stage of treatment. Many studies
are being conducted in order to assess the potential usefulness of this
prognostic information so that the therapy protocols can be altered and the
long term administration of drugs that will not result in a sustained
response be stopped. It is expected that this approach might result in
avoiding late side effects and toxicity. The degree of metabolic activity
assessed by interim FDG PET at the very beginning of chemotherapy
administration serves as a biomarker of tumor responsiveness to chemotherapy.
Because of that, more precise criteria are needed to answer the question
?what is a positive interim FDG PET finding?. Our understanding of
lymphoproliferative diseases and the effects which some therapeutic
procedures have on the metabolism of tissue contribute significantly to the
accurate interpretation of FDG-PET/CT findings. For successful utilization of
FDG PET/CT, a multidisciplinary team which includes hematology, radiation
oncology, diagnostic radiology and nuclear medicine specialists is necessary.
nema
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
PET/CT in renal and bladder cancers Balenovic, Antonija; Mihailovic, Jasna; Jazvic, Marijana ...
Archive of oncology,
01/2012, Volume:
20, Issue:
3-4
Journal Article
Peer reviewed
Open access
FDG is the most frequently used positron emission tomography probe but it has certain limitations when used in urological cancers due to its urinary elimination, which prevents the proper ...visualization of the bladder and kidneys. The introduction of co-registered PET and computed tomography (PET/CT) represents a major advance in technology and now become the new standard for many cancers. For the staging and surveillance of renal cell cancer, FDG PET/ CT had results that were at least as good as conventional methods, which are potentially harmful for the remained renal function. FDG-PET/CT is able to evaluate early response to sunitinib or sorafenib treatment in metastatic renal cell cancer. An early decrease in the mean glucose uptake was found in both soft and skeletal lesions after treatment, thus PET seems to be more advantageous compared with RECIST evaluation. In addition, the survival of patients with advanced renal cell cancer can be predicted by evaluating their SUVmax using FDG-PET/CT. Although urinary bladder cancer demonstrates sufficiently increased FDG uptake, primary tumors are difficult to identify due to the renal excretion of FDG. The accuracy of FDG-PET/CT in metabolically active metastases is generally higher when compared to conventional CT except for identifying small lung deposits. PET/CT with delayed images after a diuretic and oral hydration may improve detection of locally recurrent or residual UBC and could replace standard CT and bone scintigraphy in the presurgical staging and monitoring of patients with urinary bladder cancer. 18F-choline PET may be useful for staging of urinary bladder cancer in addition to FDG PET.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
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