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1.
Evaluating the effect of Clostridium difficile conditioned medium on fecal microbiota community structure
Sabina Horvat, Aleksander Mahnič, Martin Breskvar, Sašo Džeroski, Maja Rupnik, 2017, izvirni znanstveni članek

Opis: Clostridium difficile infection (CDI) is typically associated with disturbed gut microbiota and changes related to decreased colonization resistance against C. difficile are well described. However, nothing is known about possible effects of C. difficile on gut microbiota restoration during or after CDI. In this study, we have mimicked such a situation by using C. difficile conditioned medium of six different C. difficile strains belonging to PCR ribotypes 027 and 014/020 for cultivation of fecal microbiota. A marked decrease of microbial diversity was observed in conditioned medium of both tested ribotypes. The majority of differences occurred within the phylum Firmicutes, with a general decrease of gut commensals with putative protective functions (i.e. Lactobacillus, Clostridium_XIVa) and an increase in opportunistic pathogens (i.e. Enterococcus). Bacterial populations in conditioned medium differed between the two C. difficile ribotypes, 027 and 014/020 and are likely associated with nutrient availability. Fecal microbiota cultivated in medium conditioned by E. coli, Salmonella Enteritidis or Staphylococcus epidermidis grouped together and was clearly different from microbiota cultivated in C. difficile conditioned medium suggesting that C. difficile effects are specific. Our results show that the changes observed in microbiota of CDI patients are partially directly influenced by C. difficile.
Ključne besede: Clostridium difficile, infection, gut microbiota
Objavljeno: 12.12.2017; Ogledov: 14; Prenosov: 0
.pdf Celotno besedilo (1,82 MB)

2.
Low overlap between carbapenem resistant Pseudomonas aeruginosa genotypes isolated from hospitalized patients and wastewater treatment plants
Andrej Golle, Sandra Janežič, Maja Rupnik, 2017, izvirni znanstveni članek

Opis: The variability of carbapenem-resistant Pseudomonas aeruginosa strains (CRPA) isolated from urine and respiratory samples in a large microbiological laboratory, serving several health care settings, and from effluents of two wastewater treatment plants (WWTP) from the same region was assessed by PFGE typing and by resistance to 10 antibiotics. During the 12-month period altogether 213 carbapenem-resistant P. aeruginosa isolates were cultured and distributed into 65 pulsotypes and ten resistance profiles. For representatives of all 65 pulsotypes 49 different MLSTs were determined. Variability of clinical and environmental strains was comparable, 130 carbapenem-resistant P. aeruginosa obtained from 109 patients were distributed into 38 pulsotypes, while 83 isolates from WWTPs were classified into 31 pulsotypes. Only 9 pulsotypes were shared between two or more settings (hospital or WWTP). Ten MLST were determined for those prevalent pulsotypes, two of them (ST111 and ST235) are among most successful CRPA types worldwide. Clinical and environmental carbapenem-resistant P. aeruginosa strains differed in antibiotic resistance. The highest proportion of clinical isolates was resistant to piperacillin/tazobactam (52.3%) and ceftazidime (42.3%). The highest proportion of environmental isolates was resistant to ceftazidime (37.1%) and ciprofloxacin (35.5%). The majority of isolates was resistant only to imipenem and/or meropenem. Strains with additional resistances were distributed into nine different patterns. All of them included clinically relevant strains, while environmental strains showed only four additional different patterns.
Ključne besede: carpabenem resistance, antibiotic resistance, Pseudomonas aeruginosa, isolates
Objavljeno: 12.12.2017; Ogledov: 15; Prenosov: 0
.pdf Celotno besedilo (2,44 MB)

3.
Nove metode za ocenjevanje tveganja za razvoj metaboličnega sindroma pri otrocih
Bernarda Vogrin, 2017, doktorsko delo/naloga

Opis: Uvod. Zaradi epidemije otroške debelosti in metaboličnega sindroma lahko v prihodnosti pri otrocih pričakujemo še večje obremenitve srca in žil, čemur smo priča danes. Zgodnje odkrivanje oseb, ki so nagnjene k metaboličnim motnjam in boleznim srca in žil, lahko bistveno pripomore k načrtovanju preventive in zdravljenju bolezni. Hipoteza. Z merjenjem žilne funkcije, telesne sestave in natančno analizo serumskih lipidov lahko odkrijemo nagnjenost k metaboličnemu sindromu in boleznim srca in žil že v otroštvu, še pred pojavom kliničnih znakov. Metode. V študiji je sodelovalo 81 šolarjev starih 11–16 let. Z anketnim vprašalnikom smo pridobili podatke o njihovem socialnem okolju, prehranskih navadah in učnem uspehu. Z analizo športno vzgojnih kartonov smo ocenili njihovo telesno zmogljivost. Opravili smo meritve telesne konstitucije: telesno višino (TV), telesno težo (TT), obseg pasu (OP) in bokov (OB), kožno gubo na nadlahti (KGN) ter izračunali indeks telesne mase (BMI) in standardni odklon glede na spol in starost (SDS BMI). Telesno sestavo (odstotek maščobe (FAT %)) smo ocenjevali z bioimpedanco. Lastnosti arterijskega sistema smo merili z Arteriografom, z določanjem augmentacijskega indeksa (AIx), hitrosti pulznih valov (PWV) in centralnega sistoličnega arterijskega tlaka (SBPao). V vzorcu venozne krvi smo analizirali glukozo (GLU) in serumske lipide vključno s prostimi maščobnimi kislinami (PMK). Rezultati. AIx je značilno koreliral s TV, učnim uspehom, nekaterimi motoričnimi testi in serumskimi lipidi. PWV je značilno koreliral s TT, TV, BMI, SDS BMI, OP, OB, nekaterimi motoričnimi testi in PMK. SBPao je negativno koreliral z učnim uspehom. FAT % je kazal značilne povezave z GLU, PMK in drugimi lipidi. Pri 5 % oziroma 6 % učencev smo ugotovili zelo visoke vrednosti AIx, SBPao in PWV. Zaključki. AIx, PWV, PMK in FAT % so dobri pokazatelji začetnih žilnih in metaboličnih nepravilnosti pri otrocih in mladostnikih. Zvečana AIx in SBPao sta povezana s slabšimi učnimi in motoričnimi sposobnostmi. PWV je pri otrocih in mladostnikih zelo odvisen od telesne konstitucije.
Ključne besede: Metabolični sindrom, augmentacijski indeks, hitrost pulznih valov, otroci, bioimpedanca
Objavljeno: 29.11.2017; Ogledov: 14; Prenosov: 2
.pdf Celotno besedilo (1,91 MB)

4.
Variations in patient safety climate and perceived quality of collaboration between professions in out-of-hours care
Zalika Klemenc-Ketiš, Ellen Tveter Deilkås, Dag Hofoss, Gunnar Tschudi Bondevik, 2017, izvirni znanstveni članek

Opis: Purpose: To get an overview of health care workers perceptions of patient safety climates and the quality of collaboration in Slovenian out-of-hours health care (OOHC) between professional groups. Materials and methods: This was a cross-sectional study carried out in all (60) Slovenian OOHC clinics; 37 (61.7%) agreed to participate with 438 employees. The questionnaire consisted of the Slovenian version of the Safety Attitudes Questionnaire - Ambulatory Version (SAQ-AV). Results: The study sample consisted of 175 (70.0%) physicians, nurse practitioners, and practice nurses. Practice nurses reported the highest patient safety climate scores in all dimensions. Total mean (standard deviation) SAQ-AV score was 60.9+-15.2. Scores for quality of collaboration between different professional groups were high. The highest mean scores were reported by nurse practitioners on collaboration with practice nurses (4.4+-0.6). The lowest mean scores were reported by practice nurses on collaboration with nurse practitioners (3.8+-0.9). Conclusion: Due to large variations in Slovenian OOHC clinics with regard to how health care workers from different professional backgrounds perceive safety culture, more attention should be devoted to improving the team collaboration in OOHC. A clearer description of professional team roles should be provided.
Ključne besede: primary health care, out-of-hours medical care, patient care management
Objavljeno: 27.11.2017; Ogledov: 53; Prenosov: 1
.pdf Celotno besedilo (169,11 KB)

5.
Analiza vpliva tehnoloških dejavnikov na delovanje sistema za inhalacijsko sedacijo »AnaConDa«
Igor Karnjuš, 2017, doktorsko delo/naloga

Opis: Uvod: Pri uporabi sistema za inhalacijsko sedacijo AnaConDaTM (ACD, Sedana Medical, Uppsala, Švedska) lahko tehnološki dejavniki vplivajo na njegovo delovanje. Med sedacijo bolnika z uporabo tekočega hlapnega anestetika lahko v brizgalki nastane plinski mehurček in zaradi njega pojav autopumpinga. Namen raziskave je bil preučiti, kako izpostavljenost tekočega anestetika viru toplote, način shranjevanja hlapnega anestetika, prisotnost plinskega mehurčka v ACD-brizgalki in gravitacija vplivajo na pojav autopumpinga. Dodatno smo želeli ugotoviti, kako dihalni minutni volumni (MV), predvsem enkratni dihalni volumen (Vt), in hitrost pretoka tekočega anestetika vplivajo na izgube hlapnega anestetika iz dihalnega sistema pri uporabi ACD. Metode: Pojav autopumpinga z uporabo ACD-sistema smo testirali in vitro na štirih različnih skupinah brizgalk z dvema hlapnima anestetikoma (izofluran in sevofluran): hlapni anestetik, shranjen na sobni temperaturi ali temperaturi hladilnika, z ali brez prisotnosti plinskega mehurčka v brizgalki. Tekoči hlapni anestetik smo v ACD-sistem dovajali s pomočjo infuzijske črpalke s konstantno hitrostjo pretoka in ga ogrevali postopoma, dokler na površini brizgalke nismo dosegli temperature 50 °C. Vpliv gravitacije smo testirali ločeno, pri višinah infuzijske črpalke ± 30 cm in ± 60 cm glede na višino ACD-sistema. Med eksperimentom smo opazovali spremembe v koncentracijah hlapnega anestetika v izdihanem zraku (Fet, v vol %). Za ugotavljanje izgub hlapnega anestetika skozi filter ACD-sistema smo dodatni analizator dihalne zmesi umestili na ekspiratorno cev dihalnega sistema takoj za Y-konektom. Rezultati: Do autopumpinga je prišlo le v skupinah z začetnim plinskim mehurčkom, pri obeh hlapnih anestetikih. V teh primerih so se vrednosti Fet povečevale z naraščanjem velikosti plinskega mehurčka (ΔFet pri izofluranu = +2,5–4,2 vol %; pri sevofluranu = +0,9–2,3 vol %). V skupinah brez začetnega plinskega mehurčka so pri obeh hlapnih anestetikih vrednosti Fet ostale stabilne med celotnim eksperimentom (ΔFet = +0,1–0,3 vol %). S spremembo višine infuzijske črpalke so se vrednosti Fet le prehodno spreminjale za ± 0,1 vol %. Izgube hlapnega anestetika iz dihalnega sistema so bile pri vrednostih Fet 0,9 vol % minimalne (< 0,1 vol %), pri vrednostih Fet > 0,9 vol %, pa so izgube naraščale v odvisnosti od hitrosti pretoka tekočega anestetika in Vt. Zaključki: Na pojav autopumpinga vplivata predvsem izpostavljenost tekočega anestetika viru toplote in prisotnost plinskega mehurčka v ACD-brizgalki. Zatorej je potrebno pred pričetkom sedacije z ACD-sistemom iz brizgalke odstraniti vse vidne plinske mehurčke in odstraniti vire toplote. Na izgube hlapnega anestetika iz dihalnega sistema vplivajo zlasti vrednosti Fet in MV oz. Vt.
Ključne besede: AnaConDa, hlapni anestetiki, inhalacijska sedacija, varnost pacienta, enota intenzivne terapije
Objavljeno: 17.11.2017; Ogledov: 24; Prenosov: 11
.pdf Celotno besedilo (5,08 MB)

6.
Skrb za pacienta in varnost pri dajanju zdravil v zdravstveni negi
Dominika Vrbnjak, 2017, doktorsko delo/naloga

Opis: Izhodišča: Poznavanje vzrokov za napake pri dajanju zdravil, ovir sporočanja ter ocene sporočanja je pomembno za zagotavljanje kakovostne in varne obravnave pacientov, takšnih raziskav pa v slovenskem okolju primanjkuje. Strokovnjaki ocenjujejo, da je za varnost pacientov med drugim potrebna tudi ustrezna kultura skrbi, vendar je zaenkrat še premalo raziskav, ki bi potrdili povezanost kulture skrbi s kazalniki kakovosti in varnostjo pacientov. Z doktorsko disertacijo smo želeli raziskati zaznavanje vzrokov za napake pri dajanju zdravil, ovir sporočanja in ocene sporočanja napak ter kulturo skrbi, izraženo kot zaznavanje skrbi posameznika pri lastnem delu, pri sodelavcih in nadrejenih, v delovnem okolju ter ugotoviti njihove povezave. Metode: Izvedli smo multicentrično presečno opazovalno raziskavo z uporabo zaporednega pojasnjevalnega načrta mešanih metod na populaciji zaposlenih v zdravstveni negi na internih in kirurških oddelkih v 11 slovenskih bolnišnicah. Podatke v okviru kvantitativnega dela smo zbrali s pomočjo petih psihometrično veljavnih in zanesljivih vprašalnikov. Zbrane podatke smo nato analizirali z uporabo deskriptivne in inferenčne statistike. V okviru kvalitativnega dela smo uporabili metodo utemeljene teorije, podatke pa zbrali s pomočjo vprašanj odprtega tipa v anketnem vprašalniku in delno strukturiranimi intervjuji. Rezultati: Ugotovili smo, da so vzroki za nastanek napak organizacijske in individualne narave. Anketiranci so komponente kadrovsko-delovni procesi, komunikacija z zdravniki in znanje ocenili z najvišjimi povprečnimi ocenami. Ugotovili smo pomanjkljivo sporočanje napak, saj so anketiranci ocenili, da se na njihovem oddelku sporoči manj kot 60 % vseh napak pri dajanju zdravil (p ≤ 0,001). Kar 37,6 % pa jih je ocenilo, da se vse vrste napak sporočijo v 0–20 %. Na pomanjkljivo sporočanje napak pri dajanju zdravil vpliva več dejavnikov na organizacijski in individualni ravni, kot največji oviri pa sta bili z najvišjimi povprečnimi ocenami ocenjeni komponenti odziv in strah. Rezultati so pokazali tudi, da je zaznavanje vzrokov za napake, ovir sporočanja, ocene sporočanja in kulture skrbi odvisno od določenih demografskih značilnosti posameznika, oddelkov in ustanov. Kultura skrbi je na srednji ravni, saj so anketiranci povprečno ocenili vse elemente kulture skrbi, povprečno so ocenili k osebi osredotočeno skrb v okolju, skrb pri svojem delu pa so ocenili bolje kot skrb pri nadrejenem in sodelavcih. Anketiranci, ki so bolje ocenili k osebi osredotočeno skrb v okolju, klimo varnosti, skrb pri lastnem delu in skrb pri nadrejenem, so ocenili, da se sporoči višji odstotek napak, in sicer 61–100 % vseh napak (p ≤ 0,05). Z rezultati kvalitativne raziskave smo dobili še bolj poglobljen vpogled v obravnavano problematiko. Razprava in zaključki: Kultura skrbi je osnova za zagotavljanje varnosti pri dajanju zdravil, vendar je slednja odvisna od številnih drugih, predvsem sistemskih dejavnikov. Za boljšo varnost pri dajanju zdravil potrebujemo sistemski pristop obravnave napak. Na oddelkih in predvsem na ravni ustanov potrebujemo neobtožujočo, nekaznovalno učno kulturo, v kateri bodo zaposleni brez strahu sporočali napake.
Ključne besede: napake, sporočanje, skrb, bolnišnica, pacient, zdravila
Objavljeno: 17.11.2017; Ogledov: 49; Prenosov: 28
.pdf Celotno besedilo (4,45 MB)

7.
Efficacy of a bundle approach in preventing the incidence of ventilator associated pneumonia (VAP)
Sandra Burja, Tina Belec, Nika Bizjak, Jernej Mori, Andrej Markota, Andreja Sinkovič, 2017, izvirni znanstveni članek

Opis: Ventilator-associated pneumonia (VAP) is a potentially preventable iatrogenic illness that may develop following mechanical ventilation. A bundle for the prevention of VAP consists of different measures which may vary between institutions, and may include: elevation of the head of the bed, oral care with chlorhexidine, subglottic suctioning, daily assessment for extubation and the need for proton-pump inhibitors, use of closed suction systems, and maintaining endotracheal cuff pressure at 25 cmH2O. Our aim was to determine the efficacy of a VAP prevention bundle, consisting of the above-mentioned measures, by evaluating the incidence of VAP before (no-VAP-B group) and after (VAP-B group) the introduction of the bundle. We retrospectively evaluated the data for patients who were mechanically ventilated with an endotracheal tube, in the period between 1 September and 31 December 2014 (no-VAP-B group, n = 55, 54.5% males, mean age 67.8 ± 14.5 years) and between 1 January to 30 April 2015 (VAP-B group, n = 74, 62.1% males, mean age 64.8 ± 13.7 years). There were no statistically significant differences between no-VAP-B and VAP-B groups in demographic data, intensive care unit (ICU) mortality, hospital mortality, duration of ICU treatment, and duration of mechanical ventilation. No significant differences in the rates of VAP and early VAP (onset ≤7 days after intubation) were found between no-VAP-B and VAP-B groups (41.8% versus 25.7%, p = 0.06 and 10.9% versus 12.2%, p > 0.99, respectively). However, a significant decrease in the late VAP (onset >8 days after intubation) was found in VAP-B group compared to no-VAP-B group (13.5% versus 30.9%, p = 0.027). Overall, our results support the use of VAP prevention bundle in clinical practice.
Ključne besede: ventilator-associated pneumonia, VAP, primary prevention, epidemiology, medical devices, intratracheal intubation, bundle
Objavljeno: 13.11.2017; Ogledov: 15; Prenosov: 4
.pdf Celotno besedilo (694,98 KB)

8.
Patient safety culture in Slovenian out-of-hours primary care clinics
Zalika Klemenc-Ketiš, Ellen Tveter Deilkås, Dag Hofoss, Gunnar Tschudi Bondevik, 2017, izvirni znanstveni članek

Opis: Introduction: Patient safety culture is a concept which describes how leader and staff interaction, attitudes, routines and practices protect patients from adverse events in healthcare. We aimed to investigate patient safety culture in Slovenian out-of-hours health care (OOHC) clinics, and determine the possible factors that might be associated with it. Methods: This was a cross-sectional study, which took place in Slovenian OOHC, as part of the international study entitled Patient Safety Culture in European Out-of-Hours Services (SAFE-EUR-OOH). All the OOHC clinics in Slovenia (N=60) were invited to participate, and 37 agreed to do so; 438 employees from these clinics were invited to participate. We used the Slovenian version of the Safety Attitudes Questionnaire % an ambulatory version (SAQAV) to measure the climate of safety. Results: Out of 438 invited participants, 250 answered the questionnaire (57.1% response rate). The mean overall score % standard deviation of the SAQ was 56.6%16.0 points, of Perceptions of Management 53.6%19.6 points, of Job Satisfaction 48.5%18.3 points, of Safety Climate 59.1%22.1 points, of Teamwork Climate 72.7%16.6, and of Communication 51.5%23.4 points. Employees working in the Ravne na Koroškem region, employees with variable work shifts, and those with full-time jobs scored significantly higher on the SAQ-A V. Conclusion: The safety culture in Slovenian OOHC clinics needs improvement. The variations in the safety culture factor scores in Slovenian OOHC clinics point to the need to eliminate variations and improve working conditions in Slovenian OOHC clinics.
Ključne besede: safety culture, out-of-hours medical care, primary health care, Slovenia
Objavljeno: 03.11.2017; Ogledov: 24; Prenosov: 1
.pdf Celotno besedilo (397,20 KB)

9.
Implementing quality indicators for diabetes and hypertension in family medicine in Slovenia
Zalika Klemenc-Ketiš, Igor Švab, Tonka Poplas-Susič, 2017, izvirni znanstveni članek

Opis: Introduction: A new form of family practices was introduced in 2011 through a pilot project introducing nurse practitioners as members of team and determining a set of quality indicators. The aim of this article was to assess the quality of diabetes and hypertension management. Methods: We included all family medicine practices that were participating in the project in December 2015 (N=584). The following data were extracted from automatic electronic reports on quality indicators: gender and specialisation of the family physician, status (public servant/self-contracted), duration of participation in the project, region of Slovenia, the number of inhabitants covered by a family medicine practice, the name of IT provider, and levels of selected quality indicators. Results: Out of 584 family medicine practices that were included in this project at the end of 2015, 568 (97.3%) had complete data and could be included in this analysis. The highest values were observed for structure quality indicator (list of diabetics) and the lowest for process and outcome quality indicators. The values of the selected quality indicators were independently associated with the duration of participation in the project, some regions of Slovenia where practices were located, and some IT providers of the practices. Conclusion: First, the analysis of data on quality indicators for diabetes and hypertension in this primary care project pointed out the problems which are currently preventing higher quality of chronic patient management at the primary health care level.
Ključne besede: family practices, healthcare quality indicator, diabetes mellitus, hypertension, Slovenia
Objavljeno: 03.11.2017; Ogledov: 26; Prenosov: 2
.pdf Celotno besedilo (424,82 KB)

10.
Selection of non-small cell lung cancer patients for intercalated chemotherapy and tyrosine kinase inhibitors
Matjaž Zwitter, Antonio Rossi, Massimo Di Maio, Maja Pohar Perme, Gilberto Lopes, 2017, izvirni znanstveni članek

Opis: Background: When treating patients with advanced non-small cell lung cancer (NSCLC) with tyrosine kinase inhibitors and chemotherapy, intercalated schedule with time separation between the two classes of drugs should avoid their mutual antagonism. In a survey of published trials, we focus on relation between eligibility criteria and effectiveness of intercalated treatment. Methods: Published documents were identified using major medical databases, conference proceedings and references of published trials. Median progression-free survival (PFS) was taken as the basic parameter of treatment efficacy. Correlation between characteristics of patients and median PFS was assessed through the Pearson's correlation coefficient and the coefficient of determination, separately for first-line and second-line setting. Results: The series includes 11 single-arm trials and 18 randomized phase II or phase III trials with a total of 2903 patients. Treatment-naive patients or those in progression after first-line treatment were included in 16 and 13 trials, respectively. In 14 trials, only patients with non-squamous histology were eligible. Proportion of patients with nonsquamous carcinoma (in first-line setting), proportion of never-smokers (both in first- and second-line setting) and proportion of epidermal growth factor receptor (EGFR) mutant patients (both in first- and second-line setting) showed a moderate or strong correlation with median PFS. In six trials of intercalated treatment applied to treatment-naive EGFR-mutant patients, objective response was confirmed in 83.1% of cases and median PFS was 18.6 months. Conclusions: Most suitable candidates for intercalated treatment are treatment-naive patients with EGFR-mutant tumors, as determined from biopsy or liquid biopsy. For these patients, experience with intercalated treatment is most promising and randomized trials with comparison to the best standard treatment are warranted.
Ključne besede: lung cancer, NSCLC, intercalated treatment, EGFR, tyrosine -kinase inhibitors
Objavljeno: 30.10.2017; Ogledov: 27; Prenosov: 1
.pdf Celotno besedilo (622,21 KB)

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