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1.
Vpliv pregabalina na akutno zostrno nevralgijo
Nevenka Krčevski Škvarč, 2010, doktorska disertacija

Opis: Akutna zostrna nevralgija se pojavi ob izbruhu herpetičnega izpuščaja. Ima specifično kakovost bolečine, ki je združena s pojavi hiperalgezije in alodinije, občutenja pekočine, zbadanja, mravljinčenja in sunkovitega sekanja. Običajno izzveni hkrati z izginotjem izpuščaja. Bolečina je lahko huda, traja tudi dlje časa ali celo preide v kronično bolezen. Postzostrna nevralgija je kronična nevropatična bolečina, ki je zelo slabo odzivna na zdravljenje. Bolnikom pomembno zmanjšuje kakovost življenja. Zato so zelo pomembna vsa prizadevanja za učinkovito lajšanje akutne bolečine in preprečitev postzostrne nevralgije. V raziskavi smo proučevali učinek pregabalina v lajšanju akutne zostrne nevralgije in preprečevanju nastanka postzostrne nevralgije. Bolniki in metode Tritedenska klinična primerjalna raziskava je bila zasnovana kot prospektivna randomizirana dvojno slepa v primerjavi s placebom. Vanjo smo vključili bolnike, ki so med sedmim in štirinajstim dnevom poteka zostrne bolezni imeli močnejšo bolečino ocenjeno s 4 in več po enajsttočkovni Likertovi lestvici. V treh tednih smo jih v prvi skupini zdravili s pregabalinom po 150 do 300 mg na dan, v drugi pa s placebom. Če so potrebovali, so protibolečinsko lahko dodatno vzeli še naproksen, tramadol ali oksikodon. V času zdravljenja smo ocenjevali bolečino, alodinijo, hiperalgezijo, občutenje pekočine, zbadanje, sunkovite bolečine, kakovost spanja in omejenost telesne dejavnosti. Beležili smo dodatno porabo analgetikov in pojav neželenih učinkov. Po treh tednih zdravljenja smo opredelili pojav subakutne zostrne nevralgije. Bolnike smo dodatno po šestih mesecih znova poklicali po telefonu, da bi ugotovili in opredelili pojav postzostrne nevralgije. Rezultati V raziskavi je sodelovalo 38 bolnikov, 20 jih je bilo v skupini s pregabalinom in 18 v skupini s placebom. Med bolniki ni bilo statistično značilnih razlik glede na starost, spol, višino, težo, dermatomsko prizadetost z izpuščajem, uporabo protivirusnih zdravil, niti po trajanju akutne zostrne bolečine in dolžini raziskave. Med skupino bolnikov zdravljenih s pregabalinom in skupino, ki je uporabljala placebo, s standardno statistično analizo nismo ugotovili statistično značilnih razlik v jakosti bolečine, alodinije, hiperalgezije, občutenju pekočine, zbadanja, mravljinčenja, sunkovite bolečine, niti v kakovosti spanja in omejitvi telesne dejavnosti. V skupini s pregabalinom (15 mg  12 mg) smo ugotovili statistično značilno manjšo povprečno dnevno porabo analgetikov v ekvivalentu morfina kot v primerjavi s placebno skupino bolnikov (26 mg  12 mg). Med skupinama nismo ugotovili statistično značilne razlike pri pojavu neželenih učinkov ali subakutne in postzostrne nevralgije. V odstotkovnem prikazu podatkov smo zasledili, da so bolniki iz skupine s pregabalinom uporabljali manj analgetikov ter dosegli večje izboljšanje stanja pri vseh kakovostih bolečine in spanja. Pri njih smo ugotovili tudi manj pojavov subakutne in postzostrne nevralgije. Nespecifična ocena zdravljenja, izražena kot celostna klinična ocena zdravljenja bolečine in izboljšanja stanja, je bila boljša v skupini bolnikov s pregabalinom. Ta skupina je zdravljenje bolečine ocenila kot zelo uspešno v 55 %, bolniki v skupini s placebom v 50 % primerov. Zelo uspešno izboljšanje stanja je navedlo 50 % bolnikov iz skupine s pregabalinom in 37 % iz skupine s placebom. Prenosljivost zdravila so bolje ocenili bolniki iz skupine s placebom. Zelo dobro prenosljivost zdravila je ocenilo 40 % bolnikov iz skupine s pregabalinom in 50 % bolnikov iz skupine s placebom. Slabo prenosljivost zdravila je ocenilo 30 % bolnikov iz skupine s pregabalinom in 28 % bolnikov iz skupine s placebom. Sklep V raziskavi nismo ugotovili statistično značilnega vpliva pregabalina na akutno zostrno nevralgijo. Pri tem smo upoštevali ocene jakosti in kakovosti bolečine, kakovosti življenja, pojava neželenih učinkov ter pojav subakutne zostrne nevralgije in postzostrne nev
Ključne besede: zostrna bolezen, akutna nevralgija, postzostrna nevralgija, zdravljenje, pregabalin
Objavljeno: 19.02.2013; Ogledov: 2307; Prenosov: 160
.pdf Celotno besedilo (1,50 MB)

2.
Modelling of the risk factors and chronic diseases that influence the development of serious health complications
Maja Atanasijević-Kunc, Jože Drinovec, Simona Ručigaj, Aleš Mrhar, 2008, izvirni znanstveni članek

Opis: Background: Some chronic diseases, like diabetes type 2 and hypertension, and risk factors, such as obesity, hypercholesterolemia, and smoking, are strongly correlated with the potential development of serious health complications that can threaten a patient's life or significantly influence the quality of life, while at the same time representing an enormous economic burden. Such complications include, for example, stroke, coronary heart disease, peripheralarterial vascular disease, end-stage renal disease and congestive heart failure. Methods: For a quantitative evaluation of the mentioned patient groups, the age distribution and an estimation of the treatment expenses a dynamic mathematical model was developed, where special attention was devoted to its structure, as it should enable the sequential construction and representation of different forms of data information. The model was realized in the Matlab program package with the Simulink Toolbox. Conclusions: A dynamic mathematical model is described that enables the observation of patients (in percentage terms) with diabetes type 2 and obesity, as well as those who smoke, have hypercholesterolemia and hypertension and all possible combinations of these problems, related to their age. Taking into account the Slovenian demographic data and annual treatment expenses, we were able to quantitatively evaluate these factors, not only in Slovenia but also in other developed regions where the demographic and economic situations are similar. It is also possible to extend the model to patients with serious complications, also taking into account the population dynamics, which is the goal of the next steps in our investigation. Regarding the presented results, it is estimated that from a group of a million people, those requiring treatment for diabetes type 2 cost as much as € 19.5 millions per year, since the treatment of one patient for one year is € 355. If all the sufferers requiring such treatment were located, as a consequence of more systematic medical examinations, an additional € 16 millions would be needed. In this group of one million people, as many as 40 % are expected to develop hypercholesterolemia, of which 26 % are diagnosed and treated adequately. The annual cost for the treatment of one patient is 313, which means that for a group of a million people the costs would be € 82 millions per year. An additional € 43.5 millions would be needed if all the sufferers with hypercholesterolemia were treated. Another chronic disease is hypertension. The annual cost for treating one patient is estimated to be € 271, and so for a group of a million people the treatment costs would be € 69.5 millions. If this were extended to include so far undiscovered sufferers with this chronic disease an additional € 14.5 millions would be needed.
Ključne besede: modelling, simulation, diabetes type 2, obesity, smoking, hypercholesterolemia, hypertension
Objavljeno: 28.03.2017; Ogledov: 274; Prenosov: 49
.pdf Celotno besedilo (1,10 MB)
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3.
Simulation analysis of economic burden in hypertension and myocardial infarction treatment with beta blockers
Maja Atanasijević-Kunc, Jože Drinovec, Barbara Guštin, Aleš Mrhar, 2012, izvirni znanstveni članek

Opis: Background: Hypertension has become a very frequent chronic disease worldwide and Slovenia is no exception. It is defined as a serious risk factor for developing different cardiovascular diseases. Several important studies proved that cardiovascular diseases are the main reason of deaths in more than 50 % of cases in the developed countries. All mentioned facts are indicating that treatment costs in patients with hypertension and cardiovascular diseases represent an important economic burden, which cannot be neglected. It may also be expected that in the next few decades the situation will become even worse. The reasons are the expected earlier disease development due to unhealthy life style and the fact that people live longer and populations are growing older. The mentioned facts have motivated the study, which would enable the estimation of patients’ number in the observed population and the evaluation of economic burden when using beta blockers, drugs which have become an important choice in antihypertensive treatment and are also used in patients with different cardiovascular complications. The projections indicating the expected trends of mentioned problems in the forthcoming decades would also be of interest. Methods: To answer some of the indicated questions, a simulation model was developed, which enabled the prediction of patients with hypertension and the influence of this disease to the development of myocardial infarction. Modeling was performed using the available statistical data and published studies. Main attention was devoted to the circumstances in Slovenia, but the results were also verified using the available data for some other countries. Combination of simulation results with demographic data enabled the estimation of the number of patients observed. In addition, expenses for the observed groups of patients were evaluated and, based on that, the economic burden was estimated. The mentioned expenses include hospitalizations, drugs required and the estimated mortality-related expenses. The developed model was accomplished with dynamical mathematical structure predicting the development of population number in Slovenia in the forthcoming decades, taking into account that the demographic properties remain unchanged. Also the observation of potential scenario regarding patients’ number and thus expected economic burden distribution among younger and older population is made possible. Results: In the paper simulation results are presented which enable the estimation of patients with hypertension and their connection with those who have experienced myocardial infarction. It is possible to observe the prevalence and the number of patients in Slovenia by age. In addition, economic burden associated with the observed groups of patients is calculated taking into account needed drugs, hospitalizations and patient mortality. In such circumstances it is possible to expect that in the group of one million people approximately 264,000 are patients with hypertension for whom, when healed optimally with beta blockers, over EUR 13 million is needed per year. In the same group of one million people are also patients with myocardial infarction. Among them 11 % experienced infarction within the current year. This amounts to more than 22,000 such patients and over EUR 22 million needed for them each year. In the case of unchanged statistical demographic characteristics in the future, it can be expected that in 50 years relative economic burden for active population would become twice as high as it is now. Conclusions: For optimal treatment, hospitalization and due to mortality more than EUR 35 million per year would be needed for patients with hypertension (around 260,000 patients) and for those who have experienced myocardial infarction (around 22,000) if observing the population of one million people. As the population is growing older, it can be expected that the relative economic burden will become significantly greater for active population in the forthcoming decades.
Ključne besede: hypertension, myocardial infarction, beta blockers, economic burden, modelling, simulation
Objavljeno: 28.03.2017; Ogledov: 337; Prenosov: 23
.pdf Celotno besedilo (809,50 KB)
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4.
Modeliranje in simulacija ter njuna uporaba v medicini in farmaciji
Maja Atanasijević-Kunc, Jože Drinovec, Aleš Mrhar, 2008, pregledni znanstveni članek

Opis: Izhodišča: Modeliranje in simulacija sta se kot metodologija pojasnjevanja, analiziranja in napovedovanja delovanja različnih sistemov že tako uveljavila, da ju srečujemo praktično pri vseh znanstvenih disciplinah, kjer tudi medicina in farmacija nista izjemi. Čeprav je narava problemov ze na omenjenih področjih lahko zelo raznolika, pa omogoča razvita metodologija uporabo podobnih in sistematično organiziranih tehnik načrtovanja, pri čemer je seveda sodelovanje problemskih strokovnjakov ključnega pomena. Zaključki: Prispevek podaja pregled nekaterih pomembnejših vidikov modeliranja in simulacije na področju medicine in farmacije. V uvodu je najprej pojasnjeno temeljno izrazoslovje področja, sledi pa opis razlogov za uporabo modeliranja in simulacije kot tehnike resevanja problemov. Nato je predstavljena metodologija, ki vključuje ciklični postopek značilnih dejavnosti, delitev uporabljanih oblik modelov in načinov njihove izgradnje. Opis metodologije je zaključen z opisom načinov eksperimentiranja z modelom, kjer smo osrednjo pozornost namenili zvezni simulaciji. Predstavljene dejavnosti so ilustrirane s preprostejsimi in razumljivimi primeri s področja medicine in farmacije. Na koncu prispevka je predstavljen tudi nekoliko kompleksnejsi problem, s katerim smo želeli ilustrirati prediktivne sposobnosti modeliranja na primeru studija vpliva čezmerne telesne mase na pet bolezni, pri katerih smo upostevali tudi obstojeèe krizne vplive. Rezultati modeliranja so nadalje omogočili tudi ekonomsko vrednotenje zdravljenja debelosti in napovedovanje bolniskega staleza ter hospitalizacije opazovanih bolnikov. Modeliranje in simulacija lahko v medicini in farmaciji pojasnita in osvetlita kompleksne klinične in terapevtske okolisčine, za katere ni mogoče dobiti podatkov v klinčènih in eksperimentalnih raziskavah.
Ključne besede: modeliranje, simulacija, medicina, farmacija, farmakoekonomika
Objavljeno: 28.03.2017; Ogledov: 413; Prenosov: 53
.pdf Celotno besedilo (200,81 KB)
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5.
Pulzni tlak pri bolnikih z arterijsko hipertenzijo v Sloveniji
Marjetka Pal, Marjan Pajntar, Branimir Leskošek, Jože Drinovec, Polonca Ferk, 2011, izvirni znanstveni članek

Opis: Namen: Namen naše študije je bil določiti porazdelitev pulznega tlaka (PP), sistoličnega (SBP) in diastoličnega (DBP) krvnega tlaka v odvisnosti od spola in starosti ter ugotoviti odnos med PP, SBP in DBP. Analizirali smo podatke za 19972 bolnikov z arterijsko hipertenzijo v Sloveniji. Metode: Podatke o meritvah arterijskega krvnega tlaka (SBP, DBP) na nadlahti smo pridobili pri več kot 360 družinskih zdravnikih iz zdravstvenih kartotek bolnikov. Večino podatkov smo zbrali v obdobju 2002-2006. Rezultati: Povprečen PP je bil (71,2 +- 16,9) mmHg, povprečen SBP (172,8 +- 18,1) mmHg in povprečen DBP (101,6 +- 10,4) mmHg. Analiza z linearno regresijo je pokazala statistično značilno povezavo PP tako s starostjo (p < 0,001) kot tudi s spolom (p < 0,001). Pulzni tlak je naraščal s starostjo, pri moških in ženskah podobno. Ženske so imele statistično značilno višji PP (p < 0,001) kot moški v starostnem obdobju 35-65 let, razlika pa je bila manj izrazita po 80. letu starosti. Pulzni tlak je v črki U podobnem odnosu z DBP ter v skoraj linearnem odnosu s SBP. Zaključek: Rezultati naše študije kažejo, da je PP pri slovenskih bolnikih z arterijsko hipertenzijo odvisen tako od spola kot od starosti bolnika, na osnovi česar želimo spomniti na pomen upoštevanja PP pri načrtovanju antihipertenzivnega zdravljenja.
Ključne besede: pulse pressure, arterial hypertension, epidemiology, Slovenia
Objavljeno: 10.07.2015; Ogledov: 1243; Prenosov: 18
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