Izhodišče: Skoraj 50 % bolnikov z astmo ima v klinični praksi kljub zdravljenju po merilih GINA (Global Initiative for Asthma) neurejeno bolezen. Najpogostejši vzroki neurejene astme so: nepravilna ...uporaba vdihovalnika, slabo sodelovanje bolnika, nepravilna diagnoza astme, pridružene bolezni (rinosinuzitis, GERB (gastroezofagealna refluksna bolezen), debelost, depresija, obstruktivna nočna apneja) in tudi stalna izpostavljenost specifičnim sprožilcem astme (alergeni, zdravila in kajenje).Metode: Med 323 bolniki z neurejeno astmo v 14 zunajbolnišničnih pnevmoloških ambulantah je med decembrom 2017 in aprilom 2018 potekala opazovalna raziskava. Raziskovalci so v svojih ambulantah vnašali podatke o najpogostejših vzrokih za neurejeno astmo in hudih poslabšanjih v zadnjem letu v elektronski sistem za zbiranje podatkov.Rezultati: Najpogostejši dejavniki, povezani z neurejeno astmo, so bile pridružene bolezni v 70 % (debelost 33 %, rinosinusitis 28 %, GERB 22 %), specifični sprožilci v 56 % (izpostavljenost alergenom 39 %, zdravila 35 %, kajenje 10 %) in slabo sodelovanje bolnikov v 53 %. Trideset odstotkov bolnikov je imelo vsaj eno hudo poslabšanje v zadnjem letu. Logistična regresijska analiza je pokazala, da sta nerazumevanje vloge zdravil (95 % IZ: 1,4; 4,8; p = 0019) in odsotnost individualiziranega načrta samozdravljenja (95 %IZ:1,3; 4,3; p = 0,042) najpomembnejša vzroka za huda poslabšanja. Težko astmo po merilih GINA je imelo 23 % bolnikov, vključenih v raziskavo.Zaključek: Najpogostejši dejavniki, ki so povezani z neurejeno astmo pri vzorčni populaciji odraslih bolnikov z neurejeno astmo v zunajbolnišničnih pnevmoloških ambulantah po Sloveniji, so pridružene bolezni, specifični sprožilci in slaba adherenca bolnikov. Ti bolniki imajo še vedno huda poslabšanja. V prihodnosti bo potrebno bolnike z astmo še bolje izobraziti in jih vse oskrbeti z individualiziranim načrtom samozdravljenja astme.
Distinctive feature of hypertension is the high frequency of a komorbidnost. Patients with hypertension, as a rule, have one or several accompanying pathologies, treat the most often meeting: chronic ...obstructive pulmonary disease, cerebrovascular disease, diabetes mellitus, hypothyroidism and others. The komorbidnost leads to mutual influence on the course of diseases, character and gravity of complications, quite often complicates diagnostics, defines features of the choice of anti-hypertensive drugs. In references of the European society of cardiologists and the European society on hypertension, the American association of heart and the American Association of strokes, the Russian cardiologic society and the Russian medical society on an arterial hypertonia the approaches to tactics of maintaining patients with hypertension and the accompanying pathology based on data of evidential medicine are designated. Existence of a komorbidnost at patients with hypertension defines not only the choice of antihypertensive drugs, but also target values of arterial pressure. Recently the available representations are added with results of new researches and meta-analyses. Patients with hypertension and a komorbidnost demand individual approach, complex diagnostics and treatment taking into account all available pathologies.
Abstract
Background
There are several potential risk factors in patients with a hip fracture for a higher rate of mortality that include: comorbid disorders, poor general health, age, male gender, ...poor mobility prior to injury, type of fracture, poor cognitive status, place of residence. The aim of this study was to assess the influence of potential risk factors for six-month mortality in hip fracture patients.
Methods
The study included all patients with a hip fracture older than 65 who had been admitted to the Clinic for orthopaedic surgery during one year. One hundred and ninety-two patients were included in the study.
Results
Six months after admission due to a hip fracture, 48 patients had died (6-month mortality rate was 25%). The deceased were statistically older than the patients who had survived. Univariate regression analysis indicated that six variables had a significant effect on hip fracture patients’ survival: age, mobility prior to the fracture, poor cognitive status, activity of daily living, comorbidities and the place where they had fallen. Multivariate regression modelling showed that the following factors were independently associated with mortality at 6 months post fracture: poor cognitive status, poor mobility prior to the fracture, comorbid disease.
Conclusion
Poor cognitive status appeared to be the strongest mortality predictor. The employment of brief tests for cognitive status evaluation would enable orthopaedists to have good criteria for the choice of treatment for each patient screened.
Depresija u starosti Stoppe, Gabriela
Socijalna psihijatrija,
11/2019, Letnik:
47, Številka:
3
Journal Article
Odprti dostop
Učestalost simptoma depresije povećava se sa starošću te pogađa 10-20 % populacije. Depresija često prati tjelesne bolesti, poremećaje sna, bol i druge psihičke poremećaje. Prognoza komorbidnih ...stanja pogoršava se s komorbiditetom. Prepoznavanje i liječenje depresije relevantno je u do 90 % slučajeva samoubojstava starijih osoba. Diferencijalna dijagnoza i terapija su složenije te zahtijevaju više strpljenja, kako liječnika tako i pacijenta. Sve metode liječenja su jednako učinkovite kao i kod mlađih odraslih osoba, ali EKT je uspješnija metoda. Postoji velika stopa podcjenjivanja dijagnoze i nedovoljnog liječenja. To se pogotovo odnosi na provođenje psihoterapije. Potrebno je više intervencija u prevenciji iz perspektive zdravstvene ekonomije. Više stigma predstavlja prepreku: starost, psihološki poremećaji, veći broj pacijenata ženskog spola.
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