From virtual library over dictum and intel until refineVladimir Šimunović
, Hans-Günther Sonntag
, Richard Marz
, Maja Ostojić
, Axel Horsch
, Bojana Filej
, Danica Železnik
, Ana Marušić
, 2008, pregledni znanstveni članek
Opis: The purpose of this paper is to recall how we, medical teachers in Bosnia-Herzegovina (BH), coped with the challenge of reform in higher education and to analyze what in our doing was fashion, which trends we have chosen to follow, and what were the real, substantial and tangible results of our work. Financial support for reform across the board came through the Trans-European Program for Co-operation in Higher Education in Central and Eastern Europe (Tempus), and, since 1997, the five schools of medicine in Bosnia and Herzegovina partnered with academic institutions from nine EU countries in seven granted Tempus projects. The results were tangible: a network of medical libraries was established; medical schools were assessed internally and externally; several important documents were drafted and agreed on; a core group of faculty from Bosnia and Herzegovina was trained in new teaching methods; and research was done and published. Not less important,there were also some less tangible, but perhaps even more important fruits of this cooperation. A sense of trust was established, which is essential for any future collaborative action. Representatives from all sides, previously divided by the war, had a chance to communicate with each other, dispelling some prejudices and regaining belief that it is possible to work together. This example of the schools of medicine of Bosnia and Herzegovina shows that higher education can be a favorable arena for reconciliation. Financial incentive can serve as a catalyst in the process and the presence of impartial partners (in our case, schools of medicine from the EU) proved beneficial for establishing and maintaining trust and good-will.The conclusion is that society rebuilding can be promoted indirectly,through formal education and professional engagement,not necessarily by pressing the “opposing” sides to talk about reconciliation and sign peace declarations.
Ključne besede: medical education, Tempus, ECTS, Quality assurance, curriculum reform, catalogue, knowledge and skills
Objavljeno: 24.07.2017; Ogledov: 18; Prenosov: 0
Polno besedilo (204,63 KB)
Lower correlation between biceps femoris contraction time and maximal running speed in children than in adultsJernej Završnik
, Rado Pišot
, Tadeja Volmut
, Katja Koren
, Helena Blažun
, Peter Kokol
, Janez Vošner
, Boštjan Šimunič
, 2016, izvirni znanstveni članek
Opis: Biceps femoris is a major propulsor muscle in sprinting and its contraction time negatively correlates to the running speeds of adults. Our aim was to compare age and gender-related correlations between vastus lateralis and biceps femoris contraction times and running speeds during a longitudinal study of 9- to 14-year old children. On a yearly basis we conducted vastus lateralis and biceps femoris tensiomyographic measurements of muscle contraction time and maximal running speeds measured during 7 meter sprints with flying starts using photocells in 107 children (53 boys). Vastus lateralis contraction time was not correlated with the running speed. However, biceps femoris contraction time was negatively correlated with the running speed only in boys after the age of 12.9 years (Pearson r ranges from -0.391 to -0.426; p < 0.002). It was concluded that biceps femoris contraction time is far less correlated with running speed than in adult athletes (Pearson r = -0.60); however, the correlation is gender and age-specific. It seems that the knee flexor and hip extensor, biceps femoris, is not as yet the major determinant of running speed in 9- to 14-year old children at that age.
Ključne besede: skeletal muscles, biceps femoris, vastus lateralis, tensiomyography, pediatrics
Objavljeno: 21.07.2017; Ogledov: 41; Prenosov: 1
Polno besedilo (604,33 KB)
Partial pressure of end-tidal carbon dioxide successful predicts cardiopulmonary resuscitation in the field - a prospective observational studyMiran Kolar
, Miljenko Križmarić
, Petra Klemen
, Štefek Grmec
, 2008, izvirni znanstveni članek
Opis: Introduction: The prognosis among patients who suffer out-of-hospital cardiac arrest is poor. Higher survival rates have been observed only in patients with ventricular fibrillation who were fortunate enough to have basic and advanced life support initiated early after cardiac arrest. The ability to predict outcomes of cardiac arrest would be useful for resuscitation. Changes in expired end-tidal carbon dioxide levels during cardiopulmonary resuscitation may be a useful non-invasive predictor of successful resuscitation and survival from cardiac arrest, and help in the termination of cardiopulmonary resuscitation in the field.
Methods: This is a prospective observational study of 737 cases of victims who suffered sudden out-of-hospital cardiac arrest. The patients were intubated and the measurements of end-tidal carbon dioxide were performed. Data according to the Utstein criteria, demographic information, medical data and partial pressure of end-tidal carbon dioxide (petCO2) values were collected for each patient in cardiac arrest, by the emergency physician. We presumed that an end-tidal carbon dioxide level of 1.9 kPa (14.3 mmHg) or more after 20 minutes of standard advanced cardiac life support would predict restoration of spontaneous circulation (ROSC).
Results: Partial pressure of end-tidal carbon dioxide after 20 minutes of advanced life support averaged 0.92+/- 0.29 kPa (6.9mmHg +/- 2.2 mmHg) in patients who did not have ROSC and 4.36 +/-1.11 kPa (32.8 mmHg +/- 9.1 mmHg) in those who did (p<0,001). End-tidal carbon dioxide values of 1.9 kPa (14.3 mmHg) or less discriminated between the 402 patients with ROSC and 335 patients without ROSC. When a 20-minute end-tidal carbon dioxide value of 1.9 kPa (14.3 mmHg) or less was used as a screening test to predict ROSC, the sensitivity, specificity, positive predictive value, and negative predictive value were all 100 percent.
Conclusions: Measurements of end-tidal carbon dioxide levels of more than 1.9 kPa (14.3 mmHg) after 20 minutes should be used to accurately predict ROSC. End-tidal carbon dioxide levels should be monitored during cardiopulmonary resuscitation and considered a useful prognostic value for determining the outcome of resuscitative efforts and termination of cardio-pulmonary resuscitation in the field.
Ključne besede: out-of-hospital cardiac arrest, cardiopulmonary resuscitation, CPR, partial pressure of end-tidal carbon dioxide, PetCO2
Objavljeno: 29.06.2017; Ogledov: 23; Prenosov: 0
Polno besedilo (290,02 KB)
Capnometry in suspected pulmonary embolism with positive D-dimer on the fieldTadeja Hernja Rumpf
, Miljenko Križmarić
, Štefek Grmec
, 2009, izvirni znanstveni članek
Opis: Introduction: Pulmonary embolism (PE) is one of the greatest diagnostic challenges in prehospital emergency setting. Most patients with suspected PE have a positive D-dimer and undergo diagnostic testing. Excluding PE with additional non-invasive tests would reduce the need for further imaging tests. We aimed to determine the effectiveness of combination of clinical probability and end-tidal carbon dioxide (PetCO2) for evaluation of suspected PE with abnormal concentrations of D-dimer in prehospital emergency setting.
Methods: We assessed clinical probability of PE and PetCO2 measurement in 100 consecutive patients with suspected PE and positive D-dimer in the field. PetCO2 > 28 mmHg was considered as the best cut-off point. PE was excluded or confirmed by hospital physicians in the University Clinical Center Maribor by computer tomography (CT), ventilation/ perfusion scan echocardiography and pulmonary angiography.
Results: PE was confirmed in 41 patients. PetCO2 had a sensitivity of 92.6% (95% CI, 79 to 98%), a negative predictive value of 94.2 % (95% CI, 83 to 99%), a specificity of 83 % (95% CI, 71 to 91%) and a positive predictive value of 79.2% (95% CI, 65 to 89%). Thirty-five patients (35%) had both a low (PE unlikely) clinical probability and a normal PetCO2 (sensitivity: 100%, 95% CI: 89 to 100%) and twenty-eight patients (28%) had both a high clinical probability (PE likely) and abnormal PetCO2 (specificity: 93.2%, 95% CI: 83 to 98%).
Conclusions: The combination of clinical probability and PetCO2 may safely rule out PE in patients with suspected PE and positive D-dimer in the prehospital setting.
Ključne besede: capnometry, pulmonary embolism, D-dimer
Objavljeno: 29.06.2017; Ogledov: 19; Prenosov: 0
Polno besedilo (397,36 KB)
Insights into population health management through disease diagnoses networksKeith Feldman
, Gregor Štiglic
, Dipanwita Dasgupta
, Mark Kricheff
, Zoran Obradović
, Nitesh Chawla
, 2016, izvirni znanstveni članek
Opis: The increasing availability of electronic health care records has provided remarkable progress in the field of population health. In particular the identification of disease risk factors has flourished under the surge of available data. Researchers can now access patient data across a broad range of demographics and geographic locations. Utilizing this Big healthcare data researchers have been able to empirically identify specific high-risk conditions found within differing populations. However to date the majority of studies approached the issue from the top down, focusing on the prevalence of specific diseases within a population. Through our work we demonstrate the power of addressing this issue bottom-up by identifying specifically which diseases are higher-risk for a specific population. In this work we demonstrate that network-based analysis can present a foundation to identify pairs of diagnoses that differentiate across population segments. We provide a case study highlighting differences between high and low income individuals in the United States. This work is particularly valuable when addressing population health management within resource-constrained environments such as community health programs where it can be used to provide insight and resource planning into targeted care for the population served.
Ključne besede: population screening, risk factors, network analysis
Objavljeno: 23.06.2017; Ogledov: 24; Prenosov: 0
Polno besedilo (743,53 KB)
Microorganisms with claimed probiotic properties: an overview of recent literatureSabina Fijan
, 2014, pregledni znanstveni članek
Opis: Probiotics are defined as live microorganisms, which when administered in adequate amounts, confer a health benefit on the host. Health benefits have mainly been demonstrated for specific probiotic strains of the following genera: Lactobacillus, Bifidobacterium, Saccharomyces, Enterococcus, Streptococcus, Pediococcus, Leuconostoc, Bacillus, Escherichia coli. The human microbiota is getting a lot of attention today and research has already demonstrated that alteration of this microbiota may have far-reaching consequences. One of the possible routes for correcting dysbiosis is by consuming probiotics. The credibility of specific health claims of probiotics and their safety must be established through science-based clinical studies. This overview summarizes the most commonly used probiotic microorganisms and their demonstrated health claims. As probiotic properties have been shown to be strain specific, accurate identification of particular strains is also very important. On the other hand, it is also demonstrated that the use of various probiotics for immunocompromised patients or patients with a leaky gut has also yielded infections, sepsis, fungemia, bacteraemia. Although the vast majority of probiotics that are used today are generally regarded as safe and beneficial for healthy individuals, caution in selecting and monitoring of probiotics for patients is needed and complete consideration of risk-benefit ratio before prescribing is recommended.
Ključne besede: Lactic-acid bacteria, Lactobacillus, Bifidobacterium, Saccharomyces, Enterococcus, Streptococcus, Pediococcus, Leuconostoc, Bacillus, Escherichia coli
Objavljeno: 21.06.2017; Ogledov: 23; Prenosov: 0
Polno besedilo (267,98 KB)
Hospital textiles, are they a possible vehicle for healthcare-associated infections?Sabina Fijan
, Sonja Šostar-Turk
, 2012, pregledni znanstveni članek
Opis: Textiles are a common material in healthcare facilities; therefore it is important that they do not pose as a vehicle for the transfer of pathogens to patients or hospital workers. During the course of use hospital textiles become contaminated and laundering is necessary. Laundering of healthcare textiles is most commonly adequate, but in some instances, due to inappropriate disinfection or subsequent recontamination, the textiles may become a contaminated inanimate surface with the possibility to transfer pathogens. In this review we searched the published literature in order to answer four review questions: (1) Are there any reports on the survival of microorganisms on hospital textiles after laundering? (2) Are there any reports that indicate the presence of microorganisms on hospital textiles during use? (3) Are there any reports that microorganisms on textiles are a possible source infection of patients? (4) Are there any reports that microorganisms on textiles are a possible source infection for healthcare workers?
Ključne besede: textile hygiene, disinfection, hospital-acquired infections, inanimate surfaces, infection transmission vehicles
Objavljeno: 21.06.2017; Ogledov: 27; Prenosov: 1
Polno besedilo (137,40 KB)
Evaluation of major online diabetes risk calculators and computerized predictive modelsMajda Pajnkihar
, Gregor Štiglic
, 2015, izvirni znanstveni članek
Opis: Classical paper-and-pencil based risk assessment questionnaires are often accompanied by the online versions of the questionnaire to reach a wider population. This study focuses on the loss, especially in risk estimation performance, that can be inflicted by direct transformation from the paper to online versions of risk estimation calculators by ignoring the possibilities of more complex and accurate calculations that can be performed using the online calculators. We empirically compare the risk estimation performance between four major diabetes risk calculators and two, more advanced, predictive models. National Health and Nutrition Examination Survey (NHANES) data from 1999%2012 was used to evaluate the performance of detecting diabetes and pre-diabetes. American Diabetes Association risk test achieved the best predictive performance in category of classical paper-and-pencil based tests with an Area Under the ROC Curve (AUC) of 0.699 for undiagnosed diabetes (0.662 for pre-diabetes) and 47% (47% for pre-diabetes) persons selected for screening. Our results demonstrate a significant difference in performance with additional benefits for a lower number of persons selected for screening when statistical methods are used. The best AUC overall was obtained in diabetes risk prediction using logistic regression with AUC of 0.775 (0.734) and an average 34% (48%) persons selected for screening. However, generalized boosted regression models might be a better option from the economical point of view as the number of selected persons for screening of 30% (47%) lies significantly lower for diabetes risk assessment in comparison to logistic regression (p < 0.001), with a significantly higher AUC (p < 0.001) of 0.774 (0.740) for the pre-diabetes group. Our results demonstrate a serious lack of predictive performance in four major online diabetes risk calculators. Therefore, one should take great care and consider optimizing the online versions of questionnaires that were primarily developed as classical paper questionnaires
Ključne besede: risk calculators, predictive models, diabetes
Objavljeno: 19.06.2017; Ogledov: 20; Prenosov: 1
Polno besedilo (797,74 KB)
Comprehensible predictive modeling using regularized logistic regression and comorbidity based featuresGregor Štiglic
, Nino Fijačko
, Petra Povalej
, Fei Wang
, Alexandros Kalousis
, Boris Delibašić
, Zoran Obradović
, 2015, izvirni znanstveni članek
Opis: Different studies have demonstrated the importance of comorbidities to better understand the origin and evolution of medical complications. This study focuses on improvement of the predictive model interpretability based on simple logical features representing comorbidities. We use group lasso based feature interaction discovery followed by a post-processing step, where simple logic terms are added. In the final step, we reduce the feature set by applying lasso logistic regression to obtain a compact set of non-zero coefficients that represent a more comprehensible predictive model. The effectiveness of the proposed approach was demonstrated on a pediatric hospital discharge dataset that was used to build a readmission risk estimation model. The evaluation of the proposed method demonstrates a reduction of the initial set of features in a regression model by 72%, with a slight improvement in the Area Under the ROC Curve metric from 0.763 (95% CI: 0.755%0.771) to 0.769 (95% CI: 0.761%0.777). Additionally, our results show improvement in comprehensibility of the final predictive model using simple comorbidity based terms for logistic regression.
Ključne besede: predictive models, logistic regression, readmission classification, comorbidities
Objavljeno: 19.06.2017; Ogledov: 28; Prenosov: 1
Polno besedilo (1,13 MB)
Comparison of methods for detection of four common nosocomial pathogens on hospital textilesSabina Fijan
, Sonja Šostar-Turk
, Urška Rozman
, 2014, izvirni znanstveni članek
Opis: Introduction: Although the most common vehicle for transmission of health-care acquired infections is the personto- person transmission route, the role of environment should not be ignored and hospital linen may contribute to the spreading of nosocomial infections. The contact plate method and swabbing are common methods for sampling microorganisms on textiles; however, results are available after two days as they are based on incubation followed by phenotypeidentification. An important alternative is using quick wash-off methods followed by PCR detection, which shortens the identification process from two days to a few hours.
Methods: The following test microorganisms at different concentrations were inoculated onto textile swatches and dried overnight: Staphylococcus aureus, Klebsiella pneumoniae, Pseudomonas aeruginosa and Clostridium difficile. RODAC plate sampling as well as a non-destructive wash-off method for capturing microorganisms from the textilesusing a Morapex device were used. The elution suspension from the Morapex device was used for two methods. In the first method, classical incubation on selective media followed by phenotypic identification was used and in the second method DNA was extracted from the elution suspension followed by amplification and agarose gel electrophoresis to visualize amplified products.
Conclusions: All chosen bacteria were found using all methods. However, the most sensitive proved to be detection using PCR amplification as we detected the sample with initial concentration of 102 cfu/mL inoculated onto the textile surface before drying. The final detectablerecovered bacterial concentration on textiles was up to 10 cfu/mL.
Ključne besede: health care associated infections, hospital textiles, Staphylococcus aureus, Klebsiella pneumoniae, Pseudomonas aeruginosa, Clostridium difficile, Morapex
Objavljeno: 05.04.2017; Ogledov: 71; Prenosov: 1
Polno besedilo (811,70 KB)