S staranjem prebivalstva narašča tudi število totalnih artroplastik velikih sklepov pri bolnikih z degenerativnimi boleznimi sklepov. Po drugi strani so finančna sredstva zdravstvenega proračuna ...omejena ali se celo zmanjšujejo. Koncept kirurgije s pospešenim okrevanjem (KSPO), s katerim skrajšamo ležalno dobo bolnikov, ne da bi s tem ogrozili kakovost zdravljenja, koristi tako bolniku, kot tudi bolnišničnemu proračunu.
Koncept KSPO smo v SB Jesenice pri bolnikih za primarno totalno artroplastiko kolka in kolena začeli uvajati v letu 2014. Postopno smo ga optimizirali in nadgradili, med drugim z izobraževanjem bolnikov in njihovih svojcev pred operacijo, ter v letu 2015 vse bolnike za primarno totalno artroplastiko kolena ali kolka v celoti obravnavali v skladu z načeli KSPO.
Analizirali smo izid zdravljenja s primerjavo ležalne dobe. Mediana vrednost je pred uvedbo KSPO v letih 2013 in 2014 znašala 6,45 oz. 6,4 dni. Po uvedbi KSPO se je le-ta pomembno skrajšala. Mediana vrednost je v letih 2015, 2016 znašala 4,4 dni, v letu 2017 pa 3,5. Analizirali smo tudi pogostost ponovnih sprejemov v 30 dneh po odpustu iz bolnišnice, kjer med bolniki pred in po uvedbi KSPO ne ugotavljamo pomembnih razlik.
Koncept KSPO smo na ortopedskem oddelku SB Jesenice uspešno uvedli in tako učinkovito skrajšali ležalno dobo bolnikov po totalni artroplastiki kolena ali kolka, ne da bi ob tem povečali stopnjo zapletov. To smo dosegli z večdisciplinarnim pristopom k obravnavi bolnikov pred (izobraževanje) in med hospitalizacijo, z optimizacijo nadzora izgube krvi (rutinska uporaba traneksamične kisline) in preprečevanja bolečine (multimodalni pristop k analgeziji brez opioidov) ter z optimizacijo fizioterapije.
Background: Total arthroplasty is one of the most interesting and fast developing fields in orthopaedic surgery. Practically every joint in the human body is involved, total hip arthroplasties (THA) ...being most frequent and with the longest history. Information on long-term results and survival of different types of prosthesis is invaluable for both patients and surgeons.Patients and methods: Between 1985 and 2006 there were 1563 THAs performed in Jesenice General Hospital. Average age at the time of operation was 67 years, almost two thirds of patients were women. The reason for operation was in 72 % idiopathic arthrosis and in 14 % sequaele of dysplasia.Results: There were 1370 primary procedures and 193 revisions (12.6 %). Aseptic loosening of the implant was the most frequent reason for revision (74 %) and infection was observed in 1.5 %. In the first ten years of this research hybrid type of prosthesis was most frequently used, but nowadays, non-cemented prosthesis is used in majority of cases.Conclusions: Total hip arthroplasty is well established procedure at the Jesenice General Hospital. It considerably improves quality of life of the patient, for both, short- and long term, results are very good. New minimal invasive surgical techniques make postoperative rehabilitation faster and easier. The Register of prosthesis enables us to regularly analyze the results and provides treatment outcome information concerning the choice of prosthesis and the optimal surgical technique. Jesenice General Hospital is well recognized as one of the centers for arthroplasties in our country.
We compare the performance of several machine learning algorithms in the problem of prognostics of the femoral neck fracture recovery: the K-nearest neighbours algorithm, the semi-naive Bayesian ...classifier, backpropagation with weight elimination learning of the multilayered neural networks, the LFC (lookahead feature construction) algorithm, and the Assistant-I and Assistant-R algorithms for top down induction of decision trees using information gain and RELIEFF as search heuristics, respectively. We compare the prognostic accuracy and the explanation ability of different classifiers. Among the different algorithms the semi-naive Bayesian classifier and Assistant-R seem to be the most appropriate. We analyze the combination of decisions of several classifiers for solving prediction problems and show that the combined classifier improves both performance and the explanation ability.
Background. Total arthroplasty is one of the most interesting and fast developing fields in orthopaedic surgery. Practicaly every joint in the human body is involved with total hip arthroplasties ...being the most frequent and with the longest history.The major complication of total arthroplasty is aseptic loosening of one or both prosthetic components. Revision procedures are very difficult due to changed anatomical situation and the results are worse than after primary operations. With the growing number of total arthroplasties there is also an increase in revision procedures.Conclusions. Information on long-term results and survival of different types of prosthesis is invaluable for both patients and surgeons. The purpose of the National Registry is to provide treatment outcome information concerning the choice of prosthesis and the optimal surgical technique in individual cases. Special emphasis is to be paid on identifying risk factors for poor outcomes related to a patient, the implant and the surgical technique. Sharing this information within the profession shall cause individuals to act according to the good example. Treatment results will be improved, patients satisfaction will be considerable and the economic impact on the whole society is considerable.
Povzetek Izhodisca. Vstavitev umetnega sklepa ali totalna artroplastika je v ortopediji trenutno med najbolj zanimivimi in hitro razvijajocimi se podrocji. Najpogostejse in najstarejse so totalne ...artroplastike kolka. Zivljenjsko dobo umetnega kolcnega sklepa najpogosteje omeji proces asepticnega omajanja ene ali obeh delov proteze, kar zahteva njeno zamenjavo. Zaradi spremenjenih anatomskih razmer so revizijski posegi zelo zahtevni, rezultati pa so slabsi kot pri primarnih operacijah. Z narascanjem stevila primarnih operacij narasca tudi stevilo revizijskih posegov. Zakljucki. Podatki o dolgorocnih rezultatih delovanja in zivljenjski dobi posameznih vrst ortopedskih protez so neprecenljivi, tako za bolnike kot tudi za kirurge. Zal tovrstnih podatkov ni veliko. Register umetnih sklepov (totalnih endoprotez, TEP) je ucinkovit vir informacij, potrebnih za bolj z dejstvi podprto obravnavo vstavitev totalnih artroplastik. Namen tovrstnega registra je zagotoviti sodelujocim informacijo o rezultatih zdravljenja in tako omogociti ustrezen izbor proteze in optimalno tehniko pri posameznih primerih.
In this perspective analysis, we strive to answer the following question: how can we advance integrative biology research in the 21st century with lessons from animal science? At the University of ...Ljubljana, Biotechnical Faculty, Department of Animal Science, we share here our three lessons learned in the two decades from 2002 to 2022 that we believe could inform integrative biology, systems science, and animal science scholarship in other countries and geographies. Cultivating multiomics knowledge through a conceptual lens of integrative biology is crucial for life sciences research that can stand the test of diverse biological, clinical, and ecological contexts. Moreover, in an era of the current COVID-19 pandemic, animal nutrition and animal science, and the study of their interactions with human health (and vice versa) through integrative biology approaches hold enormous prospects and significance for systems medicine and ecosystem health.
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