Cilj je ovog rada produbiti razumijevanje etičkih dilema i izazova u radu stručnjaka pomagačkih profesija u području nasilja nad starijim osobama. Nasilje prema ljudima u starijoj dobi je ...višedimenzionalan i složen medicinski, pravni i društveni problem. Najčešći su sukobi u pravu starijih osoba na autonomiju/samoodređenje i dužnosti stručnjaka da ih zaštiti. Nepostojanje jasnih i ujednačenih definicija, zakonskih propisa i smjernica za djelovanje otežava stručnjacima rad, izbor strategija i intervencija u nekoj situaciji. Osim navedenih etičkih izazova, pojavljuje se i izazov dužnosti prijavljivanja nasilja, pri čemu stručnjaci nemaju jasne upute ni zaštitu, zatim manjak edukacije za specifično područje nasilja nad starijim osobama te neostvarivosti djelovanja multidisciplinarnog pristupa. Nadalje, stručnjacima je izazov u radu i niska razina društvene osviještenosti za ovu problematiku te percepcija starijih osoba koje ne žele pomoć, odnosno nisu sklone prijavljivanju. Polazeći od teorijskog znanja, profesionalnog iskustva, vrijednosnih načela propisanih u profesionalnim etičkim kodeksima, poznavanja okvira za donošenje etičkih odluka te napose poznavanja individualnih obilježja i situacije u kojima se nasilje dogodilo ili se događa, stručnjacima bi u najvećem broju slučajeva trebalo biti moguće donijeti ispravnu, etički utemeljenu odluku.
The aim of this paper is to deepen the understanding of the problem of violence against the elderly for experts in helping professions, given the frequent conflict of basic ethical principles. It is a multidimensional and complex medical, legal and social problem. The most common conflicting principles occur in the field of the right of the elderly to self-determination and the duties of experts in their protection. The lack of clear and uniform definitions, legal provisions and guidelines for action makes it difficult for experts to work, choose strategies and interventions in a particular situation. In addition to these ethical challenges, there is the challenge of reporting, with experts lacking clear guidance and protection, lack of education in the specific field of violence against the elderly, and the impracticability of the multidisciplinary approach. Furthermore, the challenge in the work of experts is represented by the low level of public awareness about this issue and the perception of the elderly as people who do not want help or are not inclined to report. Starting from theoretical knowledge, professional experience, value principles prescribed in professional codes of ethics, knowledge of the framework for ethical decision-making and especially knowledge of individual characteristics and situations in which violence occurred or occurs, experts should be able to make, in the majority of cases, the right, ethically based decision.
Although intermittent rivers are present in all climate regions, their biodiversity and ecosystem functions were largely overlooked in the past. Recently, considerable effort has been made to improve ...our understanding of these, however, many data gaps still remain. We conducted a study to improve knowledge of the community patterns and processes in intermittent rivers in the Dinaric Western Balkan ecoregion. We studied spatial and temporal variation of aquatic insect community composition and structure in the intermittent Krčić River over two seasons (June and December) in three river sections (spring, upper/middle and lower reaches), encompassing dominant microhabitats (phytal, boulders, cobbles, sand and xylal). Community was primarily composed of aquatic insects (92 % of the community) and seasonality was inferred as the most important factor determining its composition, diversity and abundance. This was also supported by the ecological trait information, i.e. trophic and dispersal-related community structure. The most diverse and abundant insect group were the under-investigated chironomids, thus, we discussed tolerance and intermittency indicator potential of some of these taxa. By providing new insights into temporal and spatial dynamics of aquatic insect communities, a major bioindicator component of the macroinvertebrate community used in water quality monitoring in intermittent rivers, our data support development of the intermittent river-specific and adequate management and monitoring procedures.
We monitored trends of severe COVID-19 morbidity in Slovenia during weeks 13 to 37 2021. National weekly rates of severe acute respiratory infections (SARI) cases testing positive for SARS-CoV-2 at ...admission in all hospitals varied between 0.2 and 16.3 cases per 100,000 population. Of those without previous COVID-19 diagnosis, SARI COVID-19 admission rates ranged between 0.3 and 17.5 per 100,000 unvaccinated, and 0.0 and 7.3 per 100,000 fully vaccinated individuals. National SARI COVID-19 surveillance is essential in informing COVID-19 response.
The primary objective of this randomized phase III study was to show significant difference in median time to progression (TTP) in patients with advanced NSCLC treated with single-agent gemcitabine ...maintenance therapy versus best supportive care following gemcitabine plus cisplatin initial first-line therapy.
Chemonaive patients with stage IIIB/IV NSCLC received gemcitabine 1250
mg/m
2 (days 1 and 8) plus cisplatin 80
mg/m
2 (day 1) every 21 days. Patients achieving objective response or disease stabilization following initial gemcitabine plus cisplatin therapy were randomized (2:1 fashion) to receive maintenance gemcitabine (1250
mg/m
2 on days 1 and 8 every 21 days) plus best supportive care (GEM arm), or best supportive care only (BSC arm).
Between November 1999 and November 2002, we enrolled 352 patients (median age: 57 years; stage IV disease: 74%; Karnofsky performance status (KPS) >80: 41%). Following initial therapy, 206 patients were randomized and treated with gemcitabine (138) or best supportive care (68). TTP throughout the study period was 6.6 and 5 months for GEM and BSC arms, respectively, while values for the maintenance period were 3.6 and 2.0 months (for
p
<
0.001 for both). Median overall survival (OS) throughout study was 13.0 months for GEM and 11.0 months for BSC arms (
p
=
0.195). The toxicity profile was mild, with neutropenia being most common grade 3/4 toxicities.
Maintenance therapy with gemcitabine, following initial therapy with gemcitabine plus cisplatin, was feasible, and produced significantly longer TTP compared to best supportive care alone. Further studies are warranted to establish the place of maintenance chemotherapy in patients with advanced NSCLC.
Left atrial (LA) fibrosis in patients with atrial fibrillation (AF) is associated with an increased risk of AF recurrence after catheter ablation. Therefore, we searched for clinical risk factors ...that confer an increased risk of LA fibrosis, which can influence the treatment strategy.
We included 94 patients undergoing 3-dimensional electroanatomical voltage mapping-guided catheter ablation of AF. LA low-voltage areas during sinus rhythm as a surrogate parameter of fibrosis were measured with the CARTO3 mapping system and adjusted for LA volumes obtained by computed tomography. Blood tests including N-terminal prohormone of B-type natriuretic peptide (NT-proBNP) and echocardiographic parameters of left ventricular function were also analyzed.
Patients were 62.5 ± 11.4 years old, and 29% were female. LA fibrosis was present in 65%, with 50% having a fibrotic area > 5% (≥ Utah-Stage 1). Mean left ventricular ejection fraction (LVEF) was 53.9 ± 10.5%. Patients with LA fibrosis had higher NT-proBNP levels (869 ± 1056 vs. 552 ± 859 ng/L, p = 0.001) and larger LA volumes (body surface area-corrected 63.3 ± 19.3 vs. 80 ± 27.1 mL/m2, p = 0.003). In univariable analyses, LA fibrosis was significantly associated with female gender, older age, increased LA volumes, hypertension, statin therapy, higher NT-proBNP values, and echocardiographic E/e'. In bivariable analyses, higher NT-proBNP, echocardiographic parameters of diastolic dysfunction, female gender, older age, and higher DR-FLASH scores remained as independent predictors of LA fibrosis.
In this single-center longitudinal study, surrogate parameters of elevated left-sided cardiac filling pressures such as higher NT-proBNP levels and higher echocardiographic E/e' values as well as female gender independently predicted the prevalence of LA fibrosis in patients referred for catheter ablation of AF.
The objectives of this phase III trial were to compare the time to progressive disease (TtPD), overall response rate (ORR), overall survival, and toxicity of gemcitabine, epirubicin, and paclitaxel ...(GET) versus fluorouracil (FU), epirubicin, and cyclophosphamide (FEC) as first-line therapy in patients with metastatic breast cancer (MBC).
Female patients aged 18 to 75 years with stage IV and measurable MBC were enrolled and randomly assigned to either gemcitabine (1,000 mg/m(2), days 1 and 4), epirubicin (90 mg/m(2), day 1), and paclitaxel (175 mg/m(2), day 1) or FU (500 mg/m(2), day 1), epirubicin (90 mg/m(2), day 1), and cyclophosphamide (500 mg/m(2), day 1). Both regimens were administered every 21 days for a maximum of eight cycles.
Between October 1999 and November 2002, 259 patients (GET, n = 124; FEC, n = 135) were enrolled. Baseline characteristics were well balanced across treatment arms. After a median of 20.4 months of follow-up, median TtPD was 9.1 months and 9.0 months in the GET and FEC arms, respectively (P = .557). The ORR was 62.3% in the GET arm (n = 114) and 51.2% in the FEC arm (n = 129; P = .093). Grade 3 and 4 toxicities, including neutropenia, thrombocytopenia, anemia, stomatitis, neurosensory toxicity, and allergy, occurred significantly more often in the GET arm.
No significant differences in terms of TtPD and ORR were observed between the two treatment arms. Treatment-related toxicity was higher in the GET arm.
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