Izhodišča: Na podlagi prehranske obravnave in postavljene diagnoze motnja prehranjenosti ali s prehranjenostjo povezane motnje lahko oblikujemo posamezniku prilagojeni načrt prehranskih ukrepov. Ta ...je nujen, da vzdržujemo ali izboljšamo posameznikovo prehranjenost, pripravijo in izvajajo pa ga bolnik, njegovi bližnji in večstrokovna skupina, ki deluje v okviru različnih organizacijskih oblik ukvarjanja s klinično prehrano.
Metode: Skupina 42 slovenskih strokovnjakov iz 19 slovenskih zdravstvenih ustanov je oblikovala eksplicitni terminološki dogovor. Osnovnim pojmom s področja prehranske oskrbe in organizacijskih oblik klinične prehrane smo določili slovenski termin in ustrezno terminološko definicijo, pri čemer smo izhajali tako iz strokovne literature področja kot iz jezikoslovne literature. Temelj oblikovanja terminologije so terminološke smernice Evropskega združenja za klinično prehrano in presnovo.
Rezultati: V prispevku predstavljamo slovenske termine in terminološke definicije načrta prehranskih ukrepov, prehranske podpore in prehranske terapije. Opredelili smo tudi prehransko okolje, diete, paliativno prehrano in oblike hrane ter hranjenja v klinični prehrani. Opisali smo tudi možnosti za organizacijo prehranske oskrbe v zdravstvenih in negovalnih ustanovah.
Zaključek: Poenoteno razumevanje osnovnih pojmov s področja prehranske terapije, prehranske podpore in organizacijskih oblik klinične prehrane je nujno za uspešno sporazumevanje med strokovnjaki, poenoteno poučevanje in razvoj ter vključitev organizacijskih oblik klinične prehrane v zdravstveni sistem.
Izhodišča: Pomembno vlogo pri prehranski obravnavi imata tako presejanje prehranske ogroženosti kot prehranski pregled, na podlagi katerega lahko postavimo diagnozo motnje prehranjenosti ali s ...prehranjenostjo povezane motnje. Ocena posameznikovega prehranskega stanja, ki jo pridobimo s prehransko obravnavo, je namreč ključna za načrtovanje učinkovite prehranske oskrbe. Za razvoj področja je pomembno, da so vsi termini, ki se uporabljajo pri kliničnem delu, usklajeni. Taki terminološki dokumenti v mednarodnem prostoru že obstajajo, smiselni pa so tudi za slovenščino in naše okolje.
Metode: Prispevek temelji na eksplicitnem terminološkem dogovoru skupine 42 relevantnih slovenskih strokovnjakov iz 19 slovenskih ustanov. Osnova oblikovanja terminoloških smernic je terminološki dokument Evropskega združenja za klinično prehrano in presnovo, pri čemer so bili upoštevani tudi novejši izsledki klinične prehrane.
Rezultati: Predstavljeni so slovenski termini in terminološke definicije s področja klinične prehrane. Opredeljeni so osnovni pojmi s področja prehranske obravnave, ki je praviloma del medicinske obravnave. Predstavljena sta pojma prehranska ogroženost in presejanje prehranske ogroženosti, ob čemer so navedeni tudi različni presejalni testi za presejanje prehranskih motenj in s prehranjenostjo povezanih stanj. Podrobno so opredeljeni tudi prehranski pregled in njegovi sestavni deli.
Zaključki: Tako presejanje prehranske ogroženosti kot prehranski pregled sta bistvena za diagnostično obravnavo v okviru klinične prehrane, poenoteno razumevanje terminologije pa omogoča primerno prepoznavo patoloških stanj pri bolnikih in pripravo ustreznega načrta prehranskih ukrepov.
Izhodišča: Prehransko stanje posameznika uvrščamo med ključne dejavnike njegovega zdravja. Za učinkovito individualno in multidisciplinarno obravnavo stanj, povezanih s prehranskim stanjem ...posameznika, moramo dobro poznati terminologijo klinične prehrane. Ker je klinična prehrana kot medicinska stroka razvita tudi pri nas, v tujini pa so tovrstni terminološki dokumenti že na voljo, želimo tudi v Sloveniji na podlagi konsenza oblikovati enotno terminologijo.
Metode: Prispevek je osnovan na podlagi eksplicitnega terminološkega dogovora. K sodelovanju smo povabili obsežno skupino relevantnih slovenskih strokovnjakov s kliničnih, predkliničnih in drugih področij, ki so povezana z dejavnostjo klinične prehrane v medicini, pri oblikovanju pa je sodeloval tudi terminolog s področja medicine. Kot izhodišče smo izbrali terminološke smernice Evropskega združenja za klinično prehrano in presnovo ter ob njih upoštevali najnovejša strokovna priporočila za posamezne pojme. Avtorji so bili v stiku prek osebnih srečanj in elektronske pošte. Pri končnem oblikovanju konsenza je sodelovalo 42 avtorjev iz 19 slovenskih ustanov.
Rezultati: Predstavljamo temeljne pojme, terminološke definicije in pripadajoče slovenske termine s področja klinične prehrane. Opredelili smo osnovne motnje prehranjenosti – podhranjenost, prekomerno hranjenost, neravnovesje mikrohranil in sindrom ponovnega hranjenja. Poleg tega smo opredelili tudi s prehranjenostjo povezana stanja – sarkopenijo in krhkost. Osnovne pojme smo podprli s kliničnim kontekstom, v katerem nastopajo.
Zaključki: Poenoteno razumevanje osnovnih patoloških stanj, ki jih obravnava klinična prehrana, je izhodišče za nadaljnji razvoj stroke, poleg tega pa je podlaga tudi za prehransko obravnavo in učinkovito prehransko oskrbo.
We leveraged the data of the international CREACTIVE consortium to investigate whether the outcome of traumatic brain injury (TBI) patients admitted to intensive care units (ICU) in hospitals without ...on-site neurosurgical capabilities (no-NSH) would differ had the same patients been admitted to ICUs in hospitals with neurosurgical capabilities (NSH).
The CREACTIVE observational study enrolled more than 8000 patients from 83 ICUs. Adult TBI patients admitted to no-NSH ICUs within 48 h of trauma were propensity-score matched 1:3 with patients admitted to NSH ICUs. The primary outcome was the 6-month extended Glasgow Outcome Scale (GOS-E), while secondary outcomes were ICU and hospital mortality.
A total of 232 patients, less than 5% of the eligible cohort, were admitted to no-NSH ICUs. Each of them was matched to 3 NSH patients, leading to a study sample of 928 TBI patients where the no-NSH and NSH groups were well-balanced with respect to all of the variables included into the propensity score. Patients admitted to no-NSH ICUs experienced significantly higher ICU and in-hospital mortality. Compared to the matched NSH ICU admissions, their 6-month GOS-E scores showed a significantly higher prevalence of upper good recovery for cases with mild TBI and low expected mortality risk at admission, along with a progressively higher incidence of poor outcomes with increased TBI severity and mortality risk.
In our study, centralization of TBI patients significantly impacted short- and long-term outcomes. For TBI patients admitted to no-NSH centers, our results suggest that the least critically ill can effectively be managed in centers without neurosurgical capabilities. Conversely, the most complex patients would benefit from being treated in high-volume, neuro-oriented ICUs.
Importance
While the relationship between persistent elevations in intracranial pressure (ICP) and poorer outcomes is well established for patients with traumatic brain injury (TBI), there is no ...consensus on how ICP measurements should drive treatment choices, and the effectiveness of ICP monitoring remains unknown.
Objective
To evaluate the effectiveness of ICP monitoring on short- and mid-term outcomes of patients with TBI.
Design, Setting, and Participants
CREACTIVE was a prospective cohort study that started in March 2014 and lasted 5 years. More than 8000 patients with TBI were enrolled at 83 intensive care units (ICUs) from 7 countries who joined the CREACTIVE Consortium. Patients with TBI who met the Brain Trauma Foundation guidelines for ICP monitoring were selected for the current analyses, which were performed from January to November 2022.
Exposure
Patients who underwent ICP monitoring within 2 days of injury (exposure group) were propensity score–matched to patients who were not monitored or who underwent monitoring 2 days after the injury (control group).
Main Outcome and Measure
Functional disability at 6 months as indicated by Glasgow Outcome Scale–Extended (GOS-E) score.
Results
A total of 1448 patients from 43 ICUs in Italy and Hungary were eligible for analysis. Of the patients satisfying the ICP-monitoring guidelines, 503 (34.7%) underwent ICP monitoring (median IQR age: 45 years 29-61 years; 392 males 77.9%, 111 females 22.1%) and 945 were not monitored (median IQR age: 66 years 48-78 years; 656 males 69.4%, 289 females 30.6%). After matching to balance the variables, worse 6-month recovery was observed for monitored patients compared with nonmonitored patients (death/vegetative state: 39.2% vs 40.6%; severe disability: 33.2% vs 25.4%; moderate disability: 15.7% vs 14.9%; good recovery: 11.9% vs 19.1%, respectively;
P
= .005). Monitored patients received medical therapies significantly more frequently.
Conclusions and Relevance
In this cohort study, ICP monitoring was associated with poorer recovery and more frequent medical interventions with their relevant adverse effects. Optimizing the value of ICP monitoring for TBI requires further investigation on monitoring indications, clinical interventions, and management protocols.
Izhodišča: Svetovna zdravstvena organizacija priporoča izključno dojenje prvih šest mesecev otrokove starosti in nato ob dopolnilni prehrani dojenje do drugega leta otrokove starosti ali dlje, če to ...ustreza ženski in otroku. V literaturi zasledimo, da ženske poročajo o pritiskih, naj z dojenjem prenehajo do prvega leta otrokove starosti. V raziskavi smo želeli ugotoviti, kakšno mnenje imajo o dojenju po prvem letu študenti zdravstvenih smeri na Zdravstveni fakulteti Univerze v Ljubljani. Metode: Uporabili smo kvantitativno, neeksperimentalno metodo raziskovanja. Odgovore smo pridobili s pomočjo strukturiranega vprašalnika na vzorcu 250 študentov. Za analizo podatkov smo uporabili opisno statistiko, Pearsonov korelacijski koeficient, Welchov t-test in test ANOVA. Rezultati: Ugotovili smo, da študenti, ki imajo več znanja, bolje sprejemajo dojenje po prvem letu starosti in imajo o dojenju bolj pozitivna čustva. Od vseh študijskih smeri imajo največ znanja o dojenju študenti smeri babištvo, med študenti ostalih študijskih smeri pa ni statistično značilnih razlik. Zaključek: Če želimo ustvariti optimalne pogoje za ženske, ki bi rade dojile dlje, je potrebno, da imajo zdravstveni delavci ustrezno znanje o koristih, ovirah, priporočilih in težavah, povezanih z dojenjem po prvem letu otrokove starosti. Te vsebine bi morale biti obvezno vključene v dodiplomske in podiplomske kurikulume zdravstvenih delavcev.
With the increasing number of inflammatory bowel disease (IBD) patients, it is difficult to manage them within specialised IBD teams in academic medical centres: many are therefore treated in ...nonacademic IBD centres. It is unclear whether the time to introducing biologics is the same in both settings.
We aimed to compare treatment approach with biologics in academic vs. nonacademic centres.
We analysed Slovenian national IBD registry data (UR-CARE Registry, supported by the European Crohn's and Colitis Organisation), which included 2 academic (2319 patients) and 4 nonacademic IBD (429 patients) centres.
The disease phenotype was similar in both settings. In total, 1687 patients received 2782 treatment episodes with biologics. We observed no differences in treatment episodes with TNF-alpha inhibitors (60% vs. 61%), vedolizumab (24% vs. 23%), or ustekinumab (17% vs. 16%) in academic compared to nonacademic centres ( P = 0.949). However, TNF inhibitors were less often the first biologic in academic centres (TNF inhibitors: 67.5% vs. 74.0%, vedolizumab: 20.3% vs. 17.9%, ustekinumab: 12.1% vs. 8.1%; P = 0.0096). Consequently, more patients received ustekinumab (29.8% vs. 18.3%) and vedolizumab (17.4% vs. 13.5%) and fewer TNF inhibitors (52.7% vs. 68.2%) for Crohn's disease in academic compared to nonacademic centres, with no such differences for ulcerative colitis. The time to initiation of the first biologic from diagnosis was short and similar in both settings (11.3 vs. 10.4 months, P = 0.2).
In this nationwide registry analysis, we observed that biological treatment choice was similar in academic and nonacademic settings. These findings support the decentralisation of IBD care.
ABSTRACTThe project entitled “Digital encyclopaedia of Slovenian natural and cultural heritage” (DEDI II) has been evolved as a prototype research and development project (2009-2010). It represents ...the first attempt of multimedia-rich digital representation of Slovenian natural and cultural heritage by the means of interdisciplinary work of different cultural and educational institutions. Verifiable, qualitative and complex contentof four types of heritage is co-located on a common site (immovable, movable, vividand natural heritage) with the goal to promote the heritage and educate the general public, as well as to encourage the public to create tomorrow’s heritage. A new detailed thesaurus was constructed enabling the classification of different kinds of heritage. It merges the established and newly created taxonomies of each type of heritage.To ensure the quality of published contents, the professional Editorial Board hasbeen established. The National and University Library of Slovenia (NUK), one of the fundamental institutions for collecting and keeping the written cultural heritage of Slovenia, has already participated in the conception of the first project scheme. In the second part of the DEDI project, NUK contributed a number of digitalized books selected on the basis of their historical and literary importance. Digitalized books were published on the DEDI portal under the movable cultural heritage taxonomy.
EXTENDED ABSTRACT:DEDI stands for the Digital Encyclopaedia of Natural and Cultural Heritage in Slovenia which was a result of two prototype research and development projects DEDI and DEDI II in the ...period between 2008 and 2010. The two projects were co-financed by the Ministry of Higher Education, Science and Technology and the European Regional Development Fund in the frame of research and development projects e-content and e-services. DEDI is the first attempt of multimediarich digital representation of Slovenian natural and cultural heritage on a common web site offering verifiable, qualitative and complex content to a wide range of general public. Digital content (text, video records, audio records, photographs) is enriched by 2-dimensional and/or 3-dimensional visualisation of geographical data or even by 4-dimensional models with time component. 4D models combine 3D models with the time dimension. Thus it is possible to simulate the past, the current and the future condition of natural and cultural heritage objects, their changes, growth, deterioration or oscillation. 3D and 4D models are more explanatory, plastic and attractive to the unprofessional public thus increasing the interest in the digital encyclopaedia. Technological solutions for the project were developed by the consortium partners in the field of web technologies who succeeded to locate all immovable natural and cultural heritage objects. The Google Maps web platform is normally used for 2D representations but it is often too complex to represent a large amount of data. In order to meet the needs of the digital encyclopaedia data need to be structured and linked which is one of the main advantages of Geopedia, an interactive atlas which enables active user participation in adding and editing information on Slovenia. A 3D visualisation tool Gaea+ is used for real time visualisation of 3D models offering user-friendly presentation of any geospatial information and an interactive walk-through allowing users to move in 3D space. Many advanced DEDI files (dynamic multimedia representations or dediteka) of some natural and cultural objects of national importance were created. An advanced dediteka combines several object representations into interactive non-linear stories and upgrade them in various ways. The advanced dediteka “The story of Martin Krpan and his age” is a digitised story of Martin Krpan written in 1858 by Fran Levstik enriched by the audio record. The user can read a story and listen to the Slovenian language of the Levstik’s time. Two main digitisation criteria of equal importance were used for the selection of natural and cultural heritage objects: geographical area and the content value. The article describes a 4D simulation of the urban growth of Ljubljana and the virtual reconstruction of the Žiga Zois study room. 4D simulation of the growth of Ljubljana is based on historical and contemporary sources, i.e. 3D visualisation with time component. It is based on old city plans, digitised terrain model, national topographic maps, contemporary city plan and cadastre. 3D terrain models of buildings are enriched by a city plan of a specific period of time. The historical growth of the city is represented by a 2D dynamic map with floor plans and isochrones.3D scanned exterior of the Žiga Zois Mansion is represented as well as a part of the interior with the virtual reconstruction of his study room where the collection of minerals was kept. Some specimens are 3D scanned. A few items of his literary opus are digitised, too.
PDF
