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91.
Usefulness of the patient information leaflet (PIL) and information on medicines from professionals
Tonka Poplas-Susič, Janko Kersnik, Zalika Klemenc-Ketiš, 2014, izvirni znanstveni članek

Opis: Background: The Patient information leaflet (PIL) is an important source of information for every patient. Little is known about whether patients read the PIL and whether it contains useful information. Other sources of drug-related information are professionals (a family practitioner, a pharmacist and a nurse). Informing patients on drugs improves their compliance. The aim of the study was to identify the usefulness of PIL from the perspective of the patient, to assess professionals as a source of drug-related information and to suggest changes that can improve informing and therefore patients' compliances. Methods: Four focus group interviews were conducted across different primary health care centres in the North East of Slovenia. Focus groups were composed of randomly selected patients (in total 20) who were willing to express their views on PILs, on other drug information sources and on possible improvements. A qualitative analysis of the data was based of the transcription of the audiotapes. Results: Patients read the PILs selectively. They were most interested in side effects, contraindications and the purpose of the prescribed drug. Participants reported that the language in PILs is too scientific. In the case they do not understand PILs or they recognise some of the side effects, a majority of participants decide to contact a family physician first, and less frequently a pharmacist or a nurse. A family physician is considered to be the most trustworthy source of information and patients think that pharmacists could play a more active role in patients% education. Conclusion: Current PILs offer enough partial information to patients but need some improvements in terms of better legibility and access to the most crucial information. PIL does not enable a comprehensive information with respect to patient%s health status. Most reliable source of information is considered to be a family practitioner. Pharmacists could play a more active role in the education of patients.
Ključne besede: PIL, focus groups, medicines, family practitioner
Objavljeno: 10.05.2017; Ogledov: 129; Prenosov: 0
.pdf Polno besedilo (91,61 KB)

92.
Primerjava prednosti in slabosti takojšnje ter odložene prekinitve popkovnice pri novorojenčku
Tamara Todorović, Andraž Dovnik, Iztok Takač, 2015, pregledni znanstveni članek

Opis: Izhodišča: Prekinitev popkovnice pri novorojenčku je v porodništvu še vedno predmet raz- prav. Tako ločimo takojšnjo prekinitev popkovnice, ki se običajno izvede v prvih 10, 15, 30 ali celo 60 sekundah po rojstvu, in odloženo prekinitev popkovnice, ki običajno pomeni prekinitev popkovnice več kot 60 sekund ali 2–5 minut po rojstvu, ob prenehanju pulzacij popkovnice ali ob pojavu posteljice v porodnem kanalu. Takojšnja prekinitev popkovnice je ena od treh komponent aktivnega vodenja tretje porodne dobe, ki se je v modernem porodništvu uveljavilo v zadnjem stoletju, medtem ko je v nekaterih severnoevropskih državah ponekod v ZDA in Kanadi ter v razvijajočih se državah bolj aktualen fiziološki pristop. Zaključki: V zadnjih letih se takojšnja prekinitev popkovnice v številnih smernicah vse bolj zamenjuje z odloženo prekinitvijo, saj so raziskave potrdile številne prednosti slednje. Med najpomembnejšimi prednostmi odložene prekinitve popkovnice omenjajo višjo raven hemoglobina in feritina, večje zaloge železa, zmanjšano pojavnost anemije zaradi pomanjkanja železa, boljšo kardiopulmonalno prilagoditev in daljše trajanje zgodnjega dojenja pri donošenem novorojenčku ob nespremenjeni pojavnosti poporodne krvavitve pri materi. Prednosti odložene prekinitve popkovnice se kažejo tudi pri nedonošenčkih. Kljub vsemu je potrebna previdnost zaradi možnega pojava policitemije s hiperviskoznostjo, hiperbilirubinemije in dihalne stiske.
Ključne besede: prekinitev popkovnice, tretja porodna doba, anemija, pomanjkanje železa, poporodna krvavitev
Objavljeno: 10.05.2017; Ogledov: 135; Prenosov: 0
.pdf Polno besedilo (83,43 KB)

93.
Pomen vodene razprave v simulacijah visoke stopnje posnemanja resničnosti
Igor Karnjuš, Miljenko Križmarić, Damjan Zazula, 2014, pregledni znanstveni članek

Opis: Vodena razprava (angl. debriefing) je najpomembnejši del učenja s simulacijami visoke stopnje posnemanja resničnosti, v kateri mentor pozove učeče se, da kritično ocenijo znanje in spretnosti, ki so jih pokazali med izvedbo scenarija. Kljub številnim raziskavam, ki proučujejo izobraževanje s simulacijami, je področje vodene razprave še razmeroma slabo opredeljeno. V prispevku so o sodobni literaturi povzete bistvene značilnosti vodene razprave, njene faze, tehnike in metode. Poudarjena je vloga mentorja, saj je učinkovitost vodene razrave v veliki meri odvisna ravno od njegove usposobljenosti. Podane so smernice, s katerimi mentor lahko oceni lastno uspešnost pri vodenju razprave. Prav tako je izpostavljen pomen pri kontinuiranem izobraževanju v kliničnem okolju, saj vodena razprava omogoča oceno uspešnosti izvedbe klinične obravnave in možnosti postavljanja novih strategij s ciljem doseči večjo usposobljenost zdravstvenega tima. Čeprav je vodena razprava temelj izobraževanja s simulacijami visoke stopnje posnemanja resničnosti, je tudi pomemben način učenja v kliničnem okolju. Mnogi vidiki vodene razprave so še vedno slabo raziskani, zato bo temu segmentu v prihodnosti potrebno nameniti večjo pozornost.
Ključne besede: vodena razprava, simulacije visoke stopnje posnemanja resničnosti, simulatorji bolnika, metode učenja, mentorji
Objavljeno: 10.05.2017; Ogledov: 80; Prenosov: 2
.pdf Polno besedilo (217,23 KB)

94.
Non-invasive prenatal cell-free fetal DNA testing for down syndrome and other chromosomal abnormalities
Darija Strah, Petra Ovniček, Janez Bernik, 2015, izvirni znanstveni članek

Opis: Background: Chorionic villus sampling and amniocentesis as definitive diagnostic procedures represent a gold standard for prenatal diagnosis of chromosomal abnormalities. The methods are invasive and lead to a miscarriage and fetal loss in approximately 0.5–1 %. Non-invasive prenatal DNA testing (NIPT) is based on the analysis of cell-free fetal DNA from maternal blood. It rep- resents a highly accurate screening test for detecting the most common fetal chromosomal abnormalities. In our study we present the results of NIPT testing in the Diagnostic Center Strah, Slovenia, over the last 3 years. Methods: In our study, 123 pregnant women from 11th to 18th week of pregnancy were included. All of them had First trimester assessment of risk for trisomy 21, done before NIPT testing. Results: 5 of total 6 high-risk NIPT cases (including 3 cases of Down syndrome and 2 cases of Klinefelter’s syndrome) were confirmed by fetal karyotyping. One case–Edwards syndrome was false positive. Patau syndrome, triple X syndrome or Turner syndrome were not observed in any of the cases. Furthermore, there were no false negative cases reported. In general, NIPT testing had 100 % sensitivity (95 % confidence interval: 46.29 %–100.00 %) and 98.95 % specificity (95 % confidence interval: 93.44 %–99.95 %). In determining Down syndrome alone, specificity (95 % confidence interval: 95.25 %- 100.00 %) and sensitivity (95 % confidence interval: 31.00 %–100.00 %) turned out to be 100 %. In 2015, the average turnaround time for analysis was 8.3 days from the day when the sample was taken. Repeated blood sampling was required in 2 cases (redraw rate = 1.6 %). Conclusions: Our results confirm that NIPT rep- resents a fast, safe and highly accurate advanced screening test for most common chromosomal abnormalities. In current clinical practice, NIPT would significantly decrease the number of unnecessary invasive procedures and the rate of fetal loss caused by invasive diagnostics.
Ključne besede: non-invasive prenatal DNA testing, chromosomal abnormalities, Down syndrome, pregnancy, fetal DNA
Objavljeno: 10.05.2017; Ogledov: 94; Prenosov: 1
.pdf Polno besedilo (140,48 KB)

95.
Načrtovan porod na domu
Tamara Todorović, Iztok Takač, 2016, pregledni znanstveni članek

Opis: Izhodišča: Porod na domu je sicer star toliko kot človeštvo, pa vendar v veliki večini srednje in visoko razvitih držav prevladuje mnenje, da so zaradi nepredvidljivosti zapletov porodnišnice najbolj varno okolje za rojevanje. Kljub temu obstaja peščica držav, v katerih je porod na domu integriran v sistem zdravstvenega varstva (npr. Nizozemska, Velika Britanija, Kanada). Pri porodih na domu ločimo nenačrtovane in načrtovane porode na domu, slednje pa lahko nadalje razdelimo še na porode s spremljevalcem in brez spremljevalca. V članku se bomo omejili na načrtovane porode na domu, ki pa so po svetu različno razširjeni. V Združenih državah Amerike se doma rodi 0,6–1,0 % vseh otrok, v Veliki Britaniji 2–3 %, v Kanadi 1,6 %, na Nizozemskem 20–30 %, v Avstriji in Nemčiji pa se zunaj porodnišnice rodi 1,3 % vseh otrok. Za Slovenijo število načrtovanih porodov na domu ni znano, se je pa leta 2010 pri nas 0,1 % otrok rodilo zunaj zdravstvene ustanove. Zaključki: Varnost načrtovanega poroda na domu je še vedno predmet razpravljanja. Medtem ko raziskave potrjujejo manjše število porodniških posegov in zapletov pri materah, ki rodijo doma, si podatki glede neonatalne in perinatalne umrljivosti in obolevnosti zelo nasprotujejo. To potrjuje potrebo po večjih multicentričnih raziskavah za to področje. Trenutne smernice poudarjajo predvsem dobro informiranost nosečnic glede možnih prednosti in slabosti poroda na domu in opredelitev izbirnih meril za porod na domu, indikacij za prevoz v porodnišnico med porodom ter ustrezno izobraženost porodnih spremljevalcev.
Ključne besede: porod na domu, maternalna umrljivost, perinatalna umrljivost, porodniški posegi
Objavljeno: 10.05.2017; Ogledov: 82; Prenosov: 2
.pdf Polno besedilo (96,39 KB)

96.
Evaluation of arterial hypertension control in family practice in Slovenia
Marjetka Pal, Branimir Leskošek, Marjan Pajntar, Polonca Ferk, 2014, izvirni znanstveni članek

Opis: Objective: We performed a study on almost 20,000 Slovene patients with arterial hypertension (AH) to evaluate age- and gender-dependent blood pressure control, differences in the rate of AH control in the period 2002-2008, and to validate a potential impact of selected quality indicators on blood pressure control. Methods: The study was conducted as a part of the "Quality of Healthcare in Slovenia" project, in agreement with the National Medical Ethics Committee of the Republic of Slovenia. Appropriate statistical analyses were performed and the results evaluated. Results: Arterial hypertension control was relatively high (55.8%, 95% CI: 55.1-56.5) in the period 2002-2008 and improved significantly during that period. Based on our statistical model, the improved AH control in year 2006 compared to 2002 is particularly due to lower initial blood pressure values before treatment. Uncontrolled AH was largely attributed to uncontrolled systolic blood pressure. We found positive association between AH control and the frequency of blood pressure control in less than six-month time intervals. Conclusions: According to our results, AH control in family practice in Slovenia is relatively high compared to other European countries, but the results refer only to patients visiting their family medicine physicians.
Ključne besede: arterial hypertension, epidemiology, treatment, quality indicators
Objavljeno: 10.05.2017; Ogledov: 75; Prenosov: 0
.pdf Polno besedilo (250,99 KB)

97.
Do the experiences of patients of state-employed family physicians and concessionaires in Slovenia differ?
Danica Rotar-Pavlič, Maja Sever, Zalika Klemenc-Ketiš, Igor Švab, Janko Kersnik, Wienke Boerma, 2015, izvirni znanstveni članek

Opis: Background: Family practice healthcare in Slovenia is provided by state-employed family physicians as well as concessionaires. However, both work under a contract with the National Health Insurance Institute. This study focuses on comparing patients’ experiences with Slovenian concessionaires and state-employed physicians. Methods: We performed analyses using survey data from a cross-sectional study on patient experiences, which took place from September 2011 to April 2012 as a part of the international QUALICOPC study. The Slovenian branch of this study included 1,962 patients visiting family practices. Patients were classified into two groups with respect to the registered status of their family physician. They completed the questionnaires immediately aſter visiting their family physicians. Data used in the analyses included 76 variables: 18 socio-economic and 58 variables linked to the patient’s experience. Results: The analyses showed few differences between concessionaires and state-employed family physicians. In comparison with patients of state-employed family physicians, patients of concessionaires were less likely to make an appointment for a visit (19.8 % vs. 29.2 %), were generally more frequent visitors (43.7 % vs. 50.7 %), and more oſten felt that opening hours were too restricted (25.7 % vs. 31.9 %). Patients of concessionaires believed more oſten that in general, doctors can be trusted (40.1 % vs.47.1 %). A smaller percentage of patients of concessionaires felt that their physician had the capacity to deal with personal problems as well as to provide medical care (61.9 % vs. 54.7 %). Conclusions: There are few differences in patients’ experiences of state-employed family physicians and concessionaires. Slovenian patients have a generally positive experience with family practice services regardless of the family physicians’ status. Plans for organizational change of the health sector should include patients’ perceptions of services.
Ključne besede: patient, experience, family physician, state-employed, concessionaire
Objavljeno: 10.05.2017; Ogledov: 104; Prenosov: 0
.pdf Polno besedilo (105,74 KB)

98.
Prognostic significance of uPA/PAI-1 level, HER2 status, and traditional histologic factors for survival in node-negative breast cancer patients
Nina Fokter Dovnik, Iztok Takač, 2017, izvirni znanstveni članek

Opis: Background: The association of HER2 status with urokinase plasminogen activator (uPA) and plasminogen activator inhibitor 1 (PAI-1) levels raises the question whether uPA/PAI-1 level carries additional clinically relevant prognostic information independently from HER2 status. The aim of our study was to compare the prognostic value of uPA/PAI-1 level, HER2 status, and traditional prognostic factors for survival in node-negative breast cancer patients. Patients and methods: A retrospective analysis of 858 node-negative breast cancer patients treated in Maribor University Clinical Center, Slovenia, in the years 2000-2009 was performed. Data were obtained from patient medical records. The median follow-up time was 100 months. Univariate and multivariate analyses of disease-free (DFS) and overall survival (OS) were performed using the Cox regression and the Cox proportional hazards model. Results: In univariate analysis, age, tumor size, grade, lymphovascular invasion, HER2 status and UPA/PAI-1 level were associated with DFS, and age, tumor size, grade, and uPA/PAI-1 level were associated with OS. In the multivariate model, the most important determinants of DFS were age, estrogen receptor status and uPA/PAI-1 level, and the most important factors for OS were patient age and tumor grade. The HR for death from any cause in the multivariate model was 1.98 (95% CI 0.83-4.76) for patients with high uPA and/or PAI-1 compared to patients with both values low. Conclusions: uPA/PAI-1 level clearly carries an independent prognostic value regardless of HER2 status in node-negative breast cancer and could be used in addition to HER2 and other markers to guide clinical decisions in this setting.
Ključne besede: node-negative breast cancer, adjuvant systemic treatment, survival, uPA/PAI-1, HER2 status
Objavljeno: 10.05.2017; Ogledov: 83; Prenosov: 1
.pdf Polno besedilo (577,15 KB)

99.
Incidence of positive peritoneal cytology in patients with endometrial carcinoma after hysteroscopy vs. dilatation and curettage
Andraž Dovnik, Bojana Crnobrnja, Branka Žegura, Iztok Takač, Maja Pakiž, 2017, izvirni znanstveni članek

Opis: Background: The aim of the study was to compare the frequency of positive peritoneal washings in endometrial cancer patients after either hysteroscopy (HSC) or dilatation and curettage (D&C). Patients and methods: We performed a retrospective analysis of 227 patients who underwent either HSC (N = 144) or D&C (N = 83) and were diagnosed with endometrial carcinoma at the University Medical Centre Maribor between January 2008 and December 2014. The incidence of positive peritoneal cytology was evaluated in each group. Results: There was no overall difference in the incidence of positive peritoneal washings after HSC or D&C (HSC = 13.2%; D&C = 12.0%; p = 0.803). However, a detailed analysis of stage I disease revealed significantly higher rates of positive peritoneal washings in the HSC group (HSC = 12.8%; D&C = 3.4%; p = 0.046). Among these patients, there was no difference between both groups considering histologic type (chi-square = 0.059; p = 0.807), tumour differentiation (chi-square = 3.709; p = 0.156), the time between diagnosis and operation (t = 0.930; p = 0.357), and myometrial invasion (chi-square = 5.073; p = 0.079). Conclusions: Although the diagnostic procedure did not influence the overall incidence of positive peritoneal washings, HSC was associated with a significantly higher rate of positive peritoneal cytology in stage I endometrial carcinoma compared to D&C.
Ključne besede: endometrial carcinoma, peritoneal cytology, FIGO staging, hysteroscopy, dilatation and curettage
Objavljeno: 10.05.2017; Ogledov: 51; Prenosov: 0
.pdf Polno besedilo (465,79 KB)

100.
Perioperativna zaščita z eritropoetinom centralnega živčnega sistema, ledvic in srca pri operacijah na srcu
Nikola Lakič, 2016, doktorsko delo/naloga

Opis: Izhodišča: Nevrološki zapleti po operacijah na odprtem srcu predstavljajo pomemben zdravstveni in denarni problem. Povečujejo obolevnost, umrljivost in podaljšujejo hospitalizacijo sicer uspešno operiranih srčnih bolnikov. Spekter kliničnih manifestacij nevroloških pooperativnih sprememb je raznolik, od kognitivnih motenj, ki so najpogostejše, tranzitornih ishemičnih atak, delirantnih stanj, pa vse do polno razvitih možganskih kapi. Najpogosteje gre za cerebralno embolizacijo ali pa hipoperfuzijo skupaj z ishemično/reperfuzijsko poškodbo. Zaradi naraščanja povprečne starosti operiranih bolnikov, narašča tudi verjetnost omenjenih zapletov. Hipoteze: Znanstveni dokazi, da eritropoetin (EPO) deluje kot multipotentni tkivni protektivni dejavnik, tako v srcu kot v centralnem in perifernem živčnem sistemu, odpirajo nove možnosti zdravljenja in zaščite bolnikov pred ishemičnimi nevrološkimi dogodki. Perioperativna intravenozna aplikacija humanega rekombinantnega eritropoetina (rHuEpo) pri bolnikih, operiranih na odprtem srcu z zunajtelesnim krvnim obtokom, naj bi zmanjšala nastanek prehodnih ali trajnih okvar centralnega živčevja, zmanjšala medoperativno in pooperativno okvaro srčne mišice ter pooperativno okvaro ledvic. Terapija z rHuEpo naj bi prav tako zaščitila bolnike pred posledicami akutnih pooperativnih embolij. Cilj naše raziskave je bil preveriti, ali eritropoetin deluje kot zaščitni dejavnik možganskega, srčnega in ledvičnega tkiva, pri bolnikih po operaciji na odprtem srcu, hkrati pa prepoznati kateri so tisti dejavniki, ki lahko napovedo nove ishemične zaplete. Metode: V pričujočo raziskavo smo vključili 40 bolnikov, ki so bili predvideni za revaskularizacijsko operacijo na odprtem srcu z uporabo zunajtelesega obtoka krvi. Skupini 20 bolnikov, operiranih na srcu, smo perioperativno intravenozno aplicirali 3 odmerke rHuEpo (24.000 IU) in nato ocenili tveganje za pojav neželenih nevroloških zapletov ter ishemičnih poškodb ledvic in srca. 20 bolnikom v kontrolni skupini smo aplicirali placebo. Za določitev novih nevroloških zapletov smo na vseh udeležencih izvedli magnetno resonanco možgan (MRI) in izmerili koncentracijo protiteles za N-metil-D-aspartatne (NMDA) receptorje (NR2Ab), koncentracijo nevronsko specifičnih enolaz (NSE) in serumskega S100B. Za detekcijo ishemije na srcu in ledvicah smo biokemično določili koncentracijo laktata, troponina I, kreatin kinaze-srčna frakcija (CK-MB) in kreatinina. Rezultati: Pri skupini 20 kontrolnih bolnikov, ki niso prejeli rHuEpo, smo s pomočjo MRI pri 5 (25,0 %) bolnikih dokazali nove ishemične zaplete na možganih. Bolniki z dodatkom rHuEpo niso pokazali novih pooperativnih ishemičnih sprememb. Razlika med skupinama je bila statistično značilna (p=0,021). Statističnih razlik med parametri ishemije (NMDA, CK-MB, troponin I, laktat, NSE, S100B) nismo dokazali (p>0,05), so pa bile vrednosti v skupini bolnikov s prejetim rHuEpo bistveno nižje, kot pri bolnikih, ki so prejeli placebo. Izmed vseh testiranih parametrov so visoke vrednosti laktata pred (p=0,022) in po popustitvi stiskalke (p=0,048), ter trajanju samega operativnega posega (p=0,009) lahko statistično napovedali nove pooperativne ishemične zaplete. Zaključek: Dokazali smo, da dodatek rHuEpo pomembno zmanjša tveganje za razvoj novih ishemičnih zapletov na možganih pri bolnikih operanih na odprtem srcu detektiranih z MRI. Hkrati se je aplikacija rHuEpo iskazala kot varna za bolnike in lahko klinično služi kot zaščita pred novimi ishemičnimi spremembami tkiv po operacijah na odprtem srcu.
Ključne besede: Zaščita, centralno živčevje, ledvica, srce, eritropoetin, operacije na srcu
Objavljeno: 10.05.2017; Ogledov: 133; Prenosov: 15
.pdf Polno besedilo (2,70 MB)

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