Anxiety disorders are among the most common mental disorders. Benzodiazepines belong to the group of anxiolytic sedatives and the most prescribed drugs in the world. The aim in ours study was to ...evaluate the differences in the exposure of the population to benzodiazepines (in period from 2014-2018) between Serbia, Slovenia and Croatia, the three countries of the Southwestern Balkans with varying degrees of socioeconomic development.
A academic investigator initiated, pharmacoepidemiological difference-in-difference time series analysis of population exposure to benzodiazepines between the three, geographically close Balkans countries (Slovenia, Serbia, Croatia) with varying degrees of socioeconomic development has been carried out. Study was conducted as academic investigator initiated, in a retrospective manner on monthly basis international data set from January 2014 to December 2018.
At the annual level, during the study period from January 2014 to December 2018, compared to Slovenia, Serbia and Croatia had higher DIDs, from 5 fold (Croatia) to 6 fold (Serbia), for all benzodiazepines in total. By analyzing the differences-in-difference, we have shown that influence of both time (month) and country on DIDs is significant as well as their mutual interaction (the country x month) for all benzodiazepines in total.
Serbia and Croatia must implement explicit measures of reducing benzodiazepine prescription in health primary care based on evidence-based recommendations in the indications where general medicine practitioners/family doctors most commonly prescribe these medicines. Without providing a realistic supplement/alternative to benzodiazepines such as increasing the availability of psychotherapy and improving the structure of psychiatric professionals in healthcare settings, implicit measures are not recommended for reducing prescription, implementing accountability measures for prolonged prescription of benzodiazepines, and in particular for "masked" somatic diseases. All this comes to the fore by raising economic development and socioeconomic stability.
Introduction. Right heart thrombus (RHT) is a relatively rare phenomenon found in 4% of patients with acute pulmonary embolism (PE), and some reports show that the presence of RHT is associated with ...poor outcomes. The optimal treatment of patients with PE and RHT is still controversial, with no clear consensus. Case report. A 38-year-old woman with repeated chest pain and worsening dyspnea was admitted to the hospital. The echocardiographical exam showed a large thrombus floating in the right atrium, protruding through the tricuspid valve into the right ventricle. Massive bilateral pulmonary embolism was confirmed by computed tomography pulmonary angiogram. Bearing these findings in mind and due to the clinical and hemodynamic instability of the patient, thrombolytic therapy was immediately initiated (alteplase), which resulted in excellent clinical outcomes with no adverse events at follow-up. Conclusion. Treating patients with PE and RHT is very difficult. While waiting for the results of some future randomized clinical trials on this topic, the treatment of these patients should be based on current guidelines while also considering the patient?s hemodynamic stability.
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DOBA, IZUM, KILJ, NUK, ODKLJ, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
BACKGROUNDAntimicrobial resistance presents one of the most significant threats to public health. This study aimed to examine antibiotic usage within the general population in the Republic of Serbia ...and their knowledge, attitudes, and behavior concerning this topic.METHODSWe conducted an online cross-sectional study over two weeks in December 2022, on a sample of 1014 respondents, representative of the Republic of Serbia's population. Predictors of the Antibiotic Knowledge Score (composed of four questions) were analyzed by multivariate ordinal logistic regression.RESULTSIn 2022, 76.8% of the participants from the Serbian population had taken antibiotics, mostly upon a medical prescription, with the most common reasons being upper respiratory tract infections. Only 31.3% of all respondents received any kind of advice about the rational use of antibiotics and half of them changed their opinions on using antibiotics after receiving this information. The average Antibiotic Knowledge Score was 2.6 out of 4, with 32.5% of respondents answering all knowledge questions correctly. The multivariate ordinal logistic regression analysis showed that female gender, higher education level, and the willingness to change opinions regarding the usage of antibiotics after receiving information about the rational use of antibiotics from any available source were significant predictors of better knowledge about antibiotics use. Respondents who were open to changing their opinion after receiving information about the rational use of antibiotics had 28% higher odds of higher antibiotic knowledge scores.CONCLUSIONThis is the first population-level study on public knowledge, attitudes, and practices about antibiotic use in Serbia and therefore the baseline for future research and measuring the impact of potential interventions. Our findings underline the importance of taking into account specific population characteristics, knowledge levels, and attitudes when designing educational and intervention strategies for antibiotic use. Policymakers can leverage these findings to target specific groups and enhance the population's knowledge and practices regarding rational antibiotic usage.
(1) Background: The purpose of this study was to investigate intraoperative pharmacological and nonpharmacological methods and techniques in reducing blood loss in patients following total hip or ...knee arthroplasty. (2) Methods: A retrospective cross-sectional study was conducted in patients undergoing TKA or THA surgery, electively performed at the General Hospital Valjevo, Valjevo, Serbia, in 2014 when the principles of patient blood management (PBM) were not applied at all or in part, and in 2019 when PBM principles were applied as standard. (3) Results: This study includes 197 patients, of whom 83.8% developed postoperative anemia (PA defined by haemoglobin < 12 g/dL in both sexes). Using multivariate logistic regression and ROC curve analysis, it was shown that the use of tranexamic acid (TXA) with intraoperative cell salvage (ICS) in patients without preoperative anemia reduced the incidence of PA (odds ratio = 0.081). (4) Conclusions: Preoperative diagnosis and treatment of anemia are necessary in orthopedic patients since the use of TXA with ICS strongly reduces PA in patients without preoperative anemia.
The aim of this study was to use a Serbian-language version of the disease-specific, self-report Sarcoidosis Health Questionnaire (SHQ), which was designed and originally validated in the United ...States, to assess health status in sarcoidosis patients in Serbia, as well as validating the instrument for use in the country.
This was a cross-sectional study of 346 patients with biopsy-confirmed sarcoidosis. To evaluate the health status of the patients, we used the SHQ, which was translated into Serbian for the purposes of this study. We compared SHQ scores by patient gender and age, as well as by disease duration and treatment. Lower SHQ scores indicate poorer health status.
The SHQ scores demonstrated differences in health status among subgroups of the sarcoidosis patients evaluated. Health status was found to be significantly poorer among female patients and older patients, as well as among those with chronic sarcoidosis or extrapulmonary manifestations of the disease. Monotherapy with methotrexate was found to be associated with better health status than was monotherapy with prednisone or combination therapy with prednisone and methotrexate.
The SHQ is a reliable, disease-specific, self-report instrument. Although originally designed for use in the United States, the SHQ could be a useful tool for the assessment of health status in various non-English-speaking populations of sarcoidosis patients.
Introduction: Due to the global crisis of 2008/2009, health professionals have become aware of the lack of resources in the health system when they were forced to allocate resources themselves during ...their daily work. However, it remains poorly researched how the global crisis accompanied by cost containment is reflected in the economic reasoning of health professionals. Aim : The aim of this study was to identify the dimensions of economic reasoning of health professionals who are subject to implicit influences. Methods: The academic study included a random sample of health professionals in the institutions of the Republic of Serbia, who voluntarily agreed to fill healthcare professionals' economic reasoning questionnaire with nine items (HPER-9) which contains seven dimensions: the negligence of the cost of quality by the administration and financier; the consideration of the market price and healthcare benefit; market orientation considering patient's requests the recognition of inadequate resource allocations by non-medical administrative authority; the attitude about redirecting the profit from state to private healthcare sector; the recognition of the unjustified spending by the healthcare professionals, and the physician / patient relationship. Respondents were divided into two groups according to the time of the survey. The first group of respondents was surveyed before the introduction of restrictive measures in the health system of the Republic of Serbia. The second group of respondents was surveyed after the implementation of restrictive measures due to the economic crisis. Results: Compared to the period before the introduction of economic restrictions, after their introduction, the score of the consideration of the market price and healthcare benefit as well as score of the physician / patient relationship remained unchanged, while scores of other dimensions have deteriorated. Conclusions: The negligence of quality costs of non-medical administrations, unjustified spending by healthcare professionals, the attitude about redirecting the profit from state to private healthcare sector but also the behavior of non-medical administrations, are important dimensions of economic judgment and behavior of health professionals under implicit economic influences.
Background/Aim. The diabetic foot syndrome (DFS) appears in 15% of diabetes mellitus (DM) patients and is the most common cause of hospitalization, prolonged hospital stay and lower extremity ...amputation. This study assesses the discriminant validity of the indicators of glycemic control, lipoprotein status and the body mass index (BMI) in diagnosing DFS in the DM patients. Methods. A comparative observational study was conducted with the study group composed of patients diagnosed with DM and DFS and a control group, composed of healthy volunteers. Metabolic predictors measured in the study were: fasting glycaemia (FG), postprandial glycaemia (PPG), glycated hemoglobin (HbA1c), total cholesterol, total triglyceride, low density lipoprotein (LDLc) and high density lipoprotein (HDLc). The BMI was measured as an anthropometric variable. The validity criterion of both metabolic and anthropometric variables was estimated by the Receiver Operating Characteristic (ROC) procedure. Results. A total of 70 patients with DM and 60 healthy volunteers were observed. Using the ROC procedure, five significant predictors of DFS were proved. The validity criterion for HbA1c, FG, PPG, LDLc and the BMI were in the following order: 6.3%, 6.3 mmol/L, 7.1 mmol/L, 4.39 mmol/L and 25 kg/m2, respectively. Significantly larger surfaces were found under the curve for all glycometabolic variables, compared to the surface under the curve for LDLc, as well as relative to the surface under the curve for BMI. Conclusion. Preventing DFS in patients with DM has to include intensification of diet measures along with the treatment of the increased value of fasting glycaemia, postprandial glycaemia and LDLc, even when they lower compared to the current recommended values for the patients with DM. Lowering body fat in the patients with DM has to be approached in the period of their pre-obesity.
nema
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, ODKLJ, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Background/Aim. Patients with acute coronary syndrome (ACS) and diabetes mellitus (DM) have an increased risk of major adverse cardiovascular events (MACE) after percutaneous coronary intervention ...(PCI), which is not estimated sufficiently-multidimensionally in terms of type and severity of the ACS and/or DM and angiographic findings. The study was intended to validate and develop an index of metabolic, angiographic, anatomic and clinical risk factors for one-year MACE after conducted PCI in patients with ACS and DM. Methods. A prospective cross-sectional study was performed in patients with DM and ACS. In the PCI period the following risk factors were recorded: 1) age and metabolic variables ? glycosylated hemoglobin (HbA1c), total cholesterol, and triglycerides levels in the blood; 2) endocrinological variables ? DM therapy and type of DM; 3) ACS modality; 4) radiological/anatomical variable ? SYNTAX score, and 5) clinical variables in modified age, creatinine, ejection fraction (ACEF) score. One-year MACE were recorded. Results. From a total of 136 consecutive patients, 55 of them developed at least one MACE in one-year follow-up. A high predictive risk index was evaluated that assessed particular or associated risks for one-year MACE (c statistic = 0.879) in the study population, defined by: SYNTAX score > 21, modified ACEF score > 1.38, HbA1c ? 8%, triglyceridemia ? 2.3 mmol/L in patients with insulin therapy, and ACS modality ? unstable angina pectoris. The constructed risk index for one-year MACE (MACERI) had better predictive characteristics than SYNTAX score (c statistic = 0.798), as well as ACF score (c statistic = 0.744). Conclusion. MACERI can potentially have great application in future risk factors studies for one-year MACE in patients with DM and ACS who underwent PCI, because with it the effects of these factors are measured multidimensionally at valid and accurate manner.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, ODKLJ, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Background/Aim. Accreditation is considered to be the oldest and most widespread mechanism of independent external evaluation of health care quality and is implemented in over 70 countries worldwide. ...Despite numerous studies in this field, there is still no solid evidence about its impact on health care quality and patient safety. The goal of this paper was to investigate if the accreditation process has an effect on the difference in values of health care quality indicators. Methods. The study was conducted in two tertiary level health care hospitals, one accredited, the other non-accredited. Values of seven quality indicators in the period before, during and immediately after the completion of accreditation (from 2007?2015), which measure health care quality, patient safety, the efficiency and productivity of the institution, were compared. Results. Of the seven monitored quality indicators, a positive effect of the accreditation process can be attributed to a shorter length of waiting for the first scheduled health check at the institution, shorter length of waiting for the first scheduled surgical check, lower rate of patients with decubitus as well as a decrease of the rate of hospital days per patient with acute myocardial infarction. No effect of accreditation was found on the mortality rate, mortality rate within the first 48 hours of hospitalization, and the average rate of hospital days per patient at the level of the institution. Conclusion. The process of accreditation undoubtedly intensifies activities that contribute to improving health care quality, which results in better health outcomes. Additional research in this field and new evidence about the relationship between accreditation and quality upgrading in health care institutions are required because this could motivate their managers to decide more easily to enter into this process and implement it, despite the additional efforts and financial investments associated with accreditation.
nema
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, ODKLJ, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Breast arterial calcifications (BACs) are common findings on mammography which are associated with an increased risk of the coronary artery disease (CAD). Our aim in the current study was to design ...measurement instruments of CAD prediction, with or without BACs, and its discriminatory validity in the diagnosis of CAD (expressed by Syntax score) in women. This was observational, prospective study in the women cohort which underwent mammography and angiography. In this study we have demonstrated that the total 'The Breast Arterial Calcification and Coronary Artery Disease Scale' (BACCADS) was good additional diagnostic tool for detection of patients with severe CAD.
Celotno besedilo
Dostopno za:
DOBA, IJS, IZUM, KILJ, NUK, OILJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
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