Izhodišče: Raziskovalno delo je temeljni element medicine, ker omogoča prenos znanstvenih dosežkov v vsakdanjo klinično prakso. Namen članka je predstaviti organizacijo raziskovalnega dela v ...slovenskih splošnih bolnišnicah. Posebej nas je zanimalo vprašanje, ali se glede strukture zaposlenih zdravnikov (delež zdravnikov z znanstvenimi in učiteljskimi naslovi) splošne bolnišnice razlikujejo od obeh univerzitetnih kliničnih centrov.Metode: Podatke smo pridobili z neeksperimentalno-kvantitativno metodo zbiranja podatkov. Uvodni del smo oblikovali na podlagi dejstev, raziskovalni del pa s pomočjo strukturiranega vprašalnika, ki smo ga v drugi polovici septembra 2017 poslali desetim splošnim bolnišnicam.Rezultati: V slovenskih splošnih bolnišnicah je bilo konec oktobra 2017 zaposlenih 866 specialistov in 568 drugih zdravnikov. 8,6 % zdravnikov je imelo znanstveni naslov magister oz. doktor znanosti, 1,1 % jih je imelo učiteljski naziv. Primerjava strukture zaposlenih zdravnikov glede na strokovni, znanstveni in pedagoški naziv pokaže statistično pomembne razlike med obema univerzitetnima bolnišnicama na eni strani in splošnimi bolnišnicami: χ2 = 336.62, p < 0.0001.Zaključek: Večina bolnišnic je imela v svoji strukturi organiziran raziskovalni oddelek. V primerjavi z univerzitetnima kliničnima centroma je delež zdravnikov z znanstvenimi in učiteljskimi naslovi v slovenskih splošnih bolnišnicah izrazito nižji. Z razvojem informacijske tehnologije, boljšo tehnično opremljenostjo splošnih bolnišnic in predvsem zaradi motiviranosti mladih zdravnikov za raziskovalno delo lahko upravičeno pričakujemo, da se bo razkorak med splošnimi in univerzitetnimi bolnišnicami postopoma zmanjševal.
V preteklih 40 letih smo bili priče izjemnemu razvoju intervencijske kardiologije. Strmo naraščajoče število posegov na koronarnih arterijah je dokaj hitro privedlo do potrebe po vnaprej določenem, ...strukturiranem beleženju intervencijskega dela kateterskih laboratorijev (KL) in vzpostavitvi mehanizmov za kontrolo kakovosti opravljenega dela. Nacionalna kardiološka združenja so zato osnovala registre posegov, ki omogočajo primerjavo dela med posameznimi KL, prav tako tudi na mednarodni ravni. Združenja so objavila tudi številna priporočila, katerih izpolnjevanje zagotavlja primerno kakovost in varnost posegov. V prispevku so opisani različni pristopi zagotavljanja kakovosti dela KL, priporočila Evropskega kardiološkega združenja in opis stanja v Sloveniji.
Lower heart rate variability (HRV) in a newborn might represent a risk factor for unfavourable outcome, a longer recovery after illness, and a sudden infant death. Our aim was to determine whether ...the newborn's sleeping position is associated with HRV.
We performed a prospective clinical study in 46 hospitalized cardiorespiratory stable term newborns. During sleeping, we measured the parameters of HRV in four body positions (supine, supine with tilt, prone, prone with tilt).
The TP (total power spectral density) was significantly higher when lying supine in comparison to prone (p = 0,048) and to prone with tilt (p = 0,046). The HF (high frequency of power spectral density) in the supine position without tilt tended to be higher compared to prone without tilt (p > 0,05). The LF (low frequency power) was significantly higher when lying supine compared to prone, both without tilt (p = 0,018). TP and HF showed a positive correlation with gestational but not postmenstrual age (p = 0.044 and p = 0.036, respectively).
In term newborns, sleeping position is associated with HRV. Higher TP and HF were found in the supine position, which might reflect better ANS stability. Gestational age positively correlated with TP and HF power, but only in supine position.
ISRCTN11702082, date of registration: March, 13th, 2020; retrospectively registered.
Coronary artery disease has a long preclinical phase before manifesting itself clinically due to diffuse non-obstructive disease, stenoses, or thrombosis.
We present a case of a middle-aged male ...complaining of atypical chest pain, then severe retrosternal pain, and, eventually, effort angina. We performed non-invasive testing, coronary angiography, intravascular imaging, and flow reserve tests, each as appropriate. Cardiovascular risk control, optimization of drug therapy, and percutaneous coronary intervention were considered trying to comply with the best clinical practice.
Diffuse non-obstructive coronary artery disease may present clinically in different ways. Exercise stress test might be sufficient to assess effort angina before a potential angiography. Flow reserve tests across the diseased vessel can distinguish between diffuse and focal pattern of the disease and assist in the adequate selection of therapy. Finally, intravascular imaging is invaluable for the assessment of the plaque risk features.
Background: Research work is a fundamental element of medicine because it allows the transfer of scientific achievements into daily clinical practice. The purpose of the article is to present the ...organization of research work in Slovenian general hospitals. We were particularly interested whether the structure of employed doctors (the proportion of doctors with scientific and teaching titles) of general hospitals differ from the two university medical centers. Methods: The data were obtained using the non-experimental quantitative method of data collection. The introductory part was designed on the basis of facts, and the research work was carried out using a structured questionnaire sent to ten general hospitals in the second half of September 2017. Results: At the end of October 2017, Slovenian general hospitals employed 866 specialists and 568 other physicians; 8.6 % of physicians held a Doctor of Philosophy or a Master of Science degree; 1.1 % were university teachers. A comparison of the structure of employed physicians according to their professional, scientific and academic titles shows statistically significant differences between the two university hospitals on the one hand and the general hospitals on the other: χ2 = 336.62, p < 0.0001. Conclusion: Most of the general hospitals have an organized research department in their structure. In comparison with the university hospitals, the share of physicians with scientific and academic titles in Slovenian general hospitals is significantly lower. With the development of information technology, better technical equipment of general hospitals and, in particular, the motivation of young doctors for research work, we can reasonably expect that the gap between general and university hospitals will gradually decrease.
Neonatal apnoea can be treated with caffeine, which affects the central nervous and cardiovascular systems. Heart rate variability (HRV) reflects the activity of the autonomic nervous system (ANS) ...and might be used as a measure of ANS maturation in newborns. We aimed to establish the effect of caffeine on HRV in newborns and investigated the potential correlation between HRV and postmenstrual age (PMA). In 25 haemodynamically stable newborns hospitalized due to apnoea and treated with caffeine (2.5 mg/kg), we assessed breathing frequency, arterial oxygen saturation, body temperature, and the heart rate while they were sleeping. We assessed HRV by spectral analysis using fast Fourier transformation. The same protocol was reapplied 100 h after caffeine withdrawal to assess the control parameters. Caffeine increased breathing frequency (
= 0.023) but did not affect any other parameter assessed including HRV. We established a positive correlation between postmenstrual age and HRV during treatment with caffeine as well as after caffeine had been withdrawn (total power:
= 0.044; low-frequency band:
= 0.039). Apparently, the maintenance dose of caffeine is too low to affect the heart rate and HRV. A positive correlation between PMA and HRV might reflect maturation of the ANS, irrespective of caffeine treatment.
Excessive salt intake and its impact on health is a public health problem in many regions of the world. The currently estimated dietary intake of salt among free-living adults is well above the WHO ...recommendations. Over the years, the number of residents in retirement homes has increased. Besides this, the nutrition of elderly people may be affected by physiological changes that occur with aging. The question is whether residents of retirement homes receive a more balanced diet, or whether the trend of excessive salt consumption continues even among institutionalised elderly people. Salt and potassium intake were assessed by measuring sodium and potassium excretion over 24 h in urine collected from a sample of residents of three retirement homes in the Goriška region, Slovenia. The average salt intake was 8.3 (2.9) g/day, which was significantly higher (
< 0.001) in men than in women (10.1 (3.1) vs. 7.3 (2.2) g/day, respectively). The estimated total daily potassium intake was 2.6 (0.6) g/day in men and 2.0 (0.8) g/day in women (mean 2.2 (0.8) g/day). The ratio of sodium to potassium was 1.53 (0.48). The salt intake among residents of retirement homes in the Goriška region, especially in men, exceeds the WHO recommended daily intake of <5 g. The mean daily potassium intake was below the WHO recommendations of 3.5 g/day.
Coronary lesions are supposed to be enclosed between proximal and distal reference segments (RSs), the sites with the largest lumens within the same vessel segment. Finding "healthy" landing zones ...has been fundamental for efficient stent implantation. Consequently, our study aimed to determine, using optical coherence tomography (OCT), to what degree RSs conform to this concept.
Sixty-seven patients with a mean age of 63.5 years underwent culprit lesion stenting due to acute myocardial infarction (MI) (Group 1) or stable angina (Group 2). OCT was performed with commercially available equipment; all evaluations were made at RSs and minimal lumens.
Normal vessel wall was infrequent (~10%) at RSs. Acceptable external elastic 220°) occurred in 55% to 67% and in 28% to 31% of RSs, respectively. Tissue composition at RSs was similar in both study groups except for a greater accumulation of thin-cap fibroatheromas (TCFA) in acute MI (29% in Group 1
9% in Group 2, P=0.035). Flow deterioration after stenting was associated with TCFA clusters extending from culprit main bodies into proximal RSs (P=0.008).
Optimal landing zones for stent placement should frequently be searched for beyond the culprit lesion segments although utilizing the largest intrasegmental lumens does not seem to cause immediate harm. However, TCFA at the landings should definitely be avoided.
Purpose
The aim of the study was to investigate whether a statistical model could be used for an early prediction of the head-up tilt test (HUTT) outcome from heart rate variability (HRV) and ...baroreflex sensitivity (BRS) data obtained during early stages of the HUTT.
Methods
A modified Italian protocol was used for HUTT in 105 patients with a previous history of vasovagal syncope. Beat-to-beat heart rate and blood pressure were continuously recorded. Fast Fourier transformation was used for spectral analysis of HRV and a sequence technique for measuring the BRS.
Results
Linear statistical models based on HRV and BRS data from the first 15 min of HUTT were no more accurate than always naively predicted majority class that a syncope will occur (average model out-of-sample accuracy 56.2 ± 5.1 % vs. majority class relative frequency 54.2 %). Even when HRV and BRS data from the first 30 min were used in the model, we did not obtain any predictions of meaningful practical value (75.0 ± 5.1 % accuracy vs. 72.2 % majority class).
Conclusions
While there are discernible and meaningful differences between HUTT-P and HUTT-N subjects, they are not sufficient to discriminate between the two groups and predict a syncope early in the HUTT. The results might improve with a larger set of subjects; however, we can conclude that it is not likely that syncope predictions of practical value can be obtained from aggregate HRV spectral analysis and BRS values.
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