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Nicotine depedence in patients with schizophrenia in the acute phase and stable remission
No full textCilj ovog istraživanja je usporediti razinu nikotinske ovisnosti kod pacijenata koji boluju od shizofrenije s obzirom na akutnu fazu bolesti i stabilnu remisiju.
Istraživanje je provedeno u periodu od ožujka do svibnja 2023. godine pri Kliničkom bolničkom centru Split. Ukupno je sudjelovalo 60 ispitanika od čega ih je 30 bilo u akutnoj fazi bolesti, a 30 u fazi stabilne remisije. Ispitanici su pacijenti Klinike za psihijatriju KBC-a Split koji se liječe stacionarno i ambulantno zbog shizofrenije. U ispitivanju je korišten test ovisnosti o nikotinu (Fagerström). Anketni upitnik se sastojao od 6 pitanja.
U istraživanju je potvrđena hipoteza da ispitanici u akutnoj fazi bolesti imaju veću razinu nikotinske ovisnosti u odnosu na ispitanike u fazi remisije. Potvrđena je hipoteza da ispitanici koji su u fazi remisije imaju manju razinu nikotinske ovisnosti u odnosu na ispitanike u akutnoj fazi bolesti. Razliku čine rezultati dobiveni putem Fagerströmove ankete (FTND) gdje su ispitanici pokazali da imaju većinom ponekad ili često veću razinu nikotinske ovisnosti. Potvrđena je hipoteza da se očekuje razlika u razini ovisnosti o nikotinu s obzirom na fazu bolesti.
Iz dobivenih podataka ovog istraživanja možemo zaključiti da se osobe sa shizofrenijom često suočavaju s višestrukim izazovima, uključujući i povećanu stopu pušenja duhana, što može povećati rizik od tjelesnih i duševnih problema. Očekivani rezultat da će pacijenti u akutnoj fazi bolesti imati veću razinu ovisnosti o nikotinu u odnosu na pacijente u stabilnoj remisiji shizofrenije je potvrđen ovim istraživačkim radom.The aim of this study is to compare the level of nicotine addiction in patients suffering from schizophrenia with regard to the acute phase of the disease and stable remission.
The research was conducted in the period from March to May 2023 at the Clinical Hospital Center Split. A total of 60 respondents participated, of which 30 were in the acute phase of the disease, and 30 in the stable remission phase. The subjects are patients of the Department of Psychiatry, University Hospital Center Split who are treated stationary and outpatiently for schizophrenia. The study used a nicotine addiction test (fagerstrom). The questionnaire consisted of 6 questions.
The research confirmed the hypothesis that respondents in the acute phase of the disease have a higher level of nicotine addiction compared to respondents in the stable remission phase. The hypothesis was confirmed that subjects who are in remission have a lower level of nicotine addiction compared to subjects in the acute phase of the disease. The difference is made by the results obtained through the Fagerström survey (FTND), where the respondents showed that they mostly sometimes or often have a higher level of nicotine addiction. The hypothesis that a difference in the level of nicotine dependence is expected with regard to the stage of the disease was confirmed.
From the data obtained in this research, we can conclude that people with schizophrenia often face multiple challenges, including an increased rate of tobacco smoking, which can increase the risk of physical and mental problems. The expected result that patients in the acute phase of the disease will have a higher level of nicotine addiction compared to patients in stable remission of schizophrenia was confirmed by this research work
Cyber attacks on radiological systems - Review
No full textNapretkom digitalnih tehnika snimanja (digitalni receptori slike, CT, MR) računala, računalni programi, računalne mreže i digitalne baze podataka su postali jedan od temelja suvremen radiologije. Radiološki odjel ima specifičan način rada te postoje standardi kao što su DICOM za medicinske slikovne zapise, PACS za arhiviranje i komunikaciju te HL7 za razmjenu informacija medicinskom sustavu. Kako radiologija postaje ekonomski zanimljiva grana, postaje meta za cyber napade. Ujedno, radiološki sustavi sadrže mnogo osobnih podataka koji mogu biti interesantni pojedincima. Razlozi za napade su često ostvarivanje financijske koristi, ali mogu biti i politički, ideološki ili osobni. Početak napada može biti fizički pristup radiološkim uređajima ili mrežni pristup, i same DICOM datoteke mogu biti početak napada. Napade dijelimo na one koji izravno utječu na pacijente i one koji imaju utjecaj na samu infrastrukturu. Najpoznatije vrste su denial-of-service, malware, kriptografički napadi i promjene na postavkama uređaja. Kod obrane od cyber napada bitno je osiguranje komunikacije elektroničkom poštom jer je česta kod malware napada a na računalima i uređajima održavati programe ažuriranima prema uputama proizvođača, osobito antivirusne i firewall programe. Informatička služba radiološkog odjela treba paziti na račune svih korisnika i provjeravati ovlasti sukladno radnim mjestima kako ne bi došlo do zlouporabe. Mreže moraju imati ograničenja pristupa te podijeljena prema radilištima i namjeni kako bi se otežali neželjeni pristupi. Web proxy zaštita ograničava pristup Internet lokacijama koje su potencijalno opasne. Osnove mreže odjela kao što su serveri potrebno je i fizički osigurati od pristupa, najbolje prostorijom koja se zaključava a nalazi se pod video nadzorom i alarmom. DICOM datoteke trebaju biti enkriptirane najsigurnijim dostupnim algoritmima. Kao odgovor na cyber napade potrebno je imati dogovorene postupke i takav sustav mora uvijek biti spreman. Poznati napadi na radiološke sustave su Kwampiris, Petja/NotPetya, Ryuk, Wannacry, Conti skupina i BianLian.One of the basis of today's radiological devices are computers and networks. The radiology department has a specific way of working, and there are standards such as DICOM for medical image records, PACS for archiving and communication, and HL7 for information exchange in the medical system. As radiology becomes an economically interesting branch, it becomes a target for cyber-attacks. At the same time, radiological systems contain a lot of personal data that may be of interest to individuals. The reasons for the attacks are often financial gain, but they can also be political, ideological or personal. The start of an attack can be physical access to radiological devices or network access. The DICOM files themselves can be the trigger of an attack. We divide attacks into those that directly affect patients, those that have an indirect impact, and those that affect the infrastructure itself. The most well-known types are Denial-Of-Service, malware, cryptographic attacks and making changes of device settings. When defending against cyber attacks, it is also important to secure communication by e-mail because it is common in malware attacks, and to keep programs on computers and devices updated according to the manufacturer's instructions, especially antivirus and firewall programs. The IT department of the radiology department should keep an eye on the accounts of all users and check the authorizations according to the workplaces so that there is no misuse. Networks must have access restrictions and division according to workplaces and purposes in order to make unwanted access difficult. Web proxy protection restricts access to Internet sites that are potentially dangerous. The basics of the department's network, such as servers, must also be physically secured from access, preferably with a room that can be locked and is under video surveillance and an alarm. DICOM files should be encrypted with the most secure algorithms available. In response to cyber-attacks, it is necessary to have agreed procedures and such a system must always be on standby. Known attacks on radiological systems are Kwampiris, Petja/NotPetya, Ryuk, Wannacry, Conti group and BianLian
American approach to healthcare financing
No full textZdravstveni sustav Sjedinjenih Država ima značajne prednosti i značajne slabosti. Ima veliku i dobro obučenu zdravstvenu radnu snagu, širok raspon visokokvalitetnih medicinskih stručnjaka, kao i sekundarnih i tercijarnih ustanova, snažan istraživački program zdravstvenog sektora i, za odabrane usluge, među najboljim medicinskim rezultatima u svijetu. Ali također pati od nepotpune pokrivenosti svog stanovništva, razina izdataka za zdravstvo po osobi koje daleko premašuju sve druge zemlje, loših mjera mnogih objektivnih i subjektivnih mjera kvalitete i ishoda, nejednake distribucije resursa i ishoda u cijeloj zemlji i među različitim skupinama stanovništva.
Teško je odrediti u kojoj su mjeri nedostaci povezani sa zdravstvenim sustavom, iako se čini da su barem neki od problema posljedica lošeg pristupa skrbi. Zbog usvajanja Affordable Care Act (ACA) 2010. godine, Sjedinjene Države suočavaju se s razdobljem golemih potencijalnih promjena. Poboljšanje pokrivenosti središnji je cilj, predviđeno kroz subvencije za neosigurane osobe za kupnju privatnog osiguranja, proširenu podobnost za Medicaid ( u nekim državama) i veću zaštitu osiguranika. Nadalje, primarna zdravstvena zaštita i javno zdravstvo dobivaju veća sredstva, a kvalitetom i izdacima rješava se niz mjera. Hoće li ACA doista biti učinkovita u rješavanju gore navedenih izazova može se odrediti tek s vremenom.
Američki zdravstveni sustav često se naziva skupim i neučinkovitim nesustavom. Postoje mnogi dionici i pružatelji usluga, visoki troškovi i lošiji zdravstveni rezultati stanovništva od onih postignutih u drugim industrijaliziranim zemljama kao što su Britanija, Njemačka i Kanada. Zdravstveni sustav je rasprostranjen s visokim razinama pokrivenosti za različite planove osiguranja kroz osiguranje temeljeno na zapošljavanju zajedno s javno financiranim i upravljanim zdravstvenim osiguranjem. Rješavanje najzahtjevnijih pitanja financiranja, isporuke i politike zdravstvene skrbi ovisi koliko o pronalaženju zajedničkog jezika toliko i o medicinskim, društvenim, bihevioralnim i organizacijskim znanostima.The United States health care system has significant strengths and significant weaknesses. It has a large and well-trained healthcare workforce, a wide range of high-quality medical professionals as well as secondary and tertiary facilities, a strong health sector research program and, for selected services, among the best medical outcomes in the world. But it also suffers from incomplete coverage of its population, levels of health expenditure per person that far exceed all other countries, poor measures of many objective and subjective measures of quality and outcomes, unequal distribution of resources and outcomes across the country and among different population groups.
It is difficult to determine the extent to which the deficiencies are related to the health care system, although at least some of the problems appear to be due to poor access to care. With the passage of the Affordable Care Act (ACA) in 2010, the United States is facing a period of enormous potential change. Improving coverage is a central goal, envisioned through subsidies for the uninsured to purchase private insurance, expanded Medicaid eligibility (in some states), and greater protections for the insured. Furthermore, primary health care and public health receive more funding, and quality and expenditure are addressed by a number of measures. Whether the ACA will actually be effective in addressing the above challenges can only be determined with time.
The American health care system is often called an expensive and inefficient system. There are many stakeholders and service providers, high costs and poorer population health outcomes than those achieved in other industrialized countries such as Britain, Germany and Canada. The health care system is widespread with high levels of coverage for various insurance plans through employment-based insurance along with publicly funded and managed health insurance. Solving health care's most challenging financing, delivery, and policy issues depends as much on finding common ground as it does on the medical, social, behavioral, and organizational sciences
Adaptive radiotherapy of prostate cancer - review
No full textOvaj diplomski rad analizira temu adaptivne radioterapije kao naprednog i inovativnog pristupa u liječenju karcinoma prostate, naglašavajući njezine prednosti u odnosu na konvencionalne tehnike zračenja. Tradicionalne metode radioterapije često ne mogu uzeti u obzir dnevne promjene u anatomiji pacijenta što može rezultirati suboptimalnom isporukom doze te povećanim rizikom od oštećenja zdravih tkiva te organa od rizika. Adaptivna radioterapija rješava ovaj problem omogućujući prilagodbu plana liječenja tijekom svake sesije koristeći napredne tehnike poput multiparametrijske magnetske rezonancije i MR-Linac tehnologije.
Primjena adaptivne radioterapije uključuje detaljno konturiranje ciljnog volumena zračenja te organa od rizika na temelju dnevnih snimaka čime se postiže veća preciznost u isporuci doze te se smanjuju neželjeni učinci na okolna zdrava tkiva. U usporedbi s konvencionalnim tehnikama poput 3D konformalnog zračenja ili radioterapijom modularnog intenziteta, adaptivna radioterapija omogućuje bolje praćenje i prilagodbu plana liječenja u stvarnom vremenu što dovodi do značajnih kliničkih poboljšanja.
U radu su također razmatrani tehnički aspekti implementacije adaptivne radioterapije uključujući upotrebu naprednih softverskih rješenja za optimizaciju plana i izračuna doze kao i potrebe za dodatnom edukacijom stručnog osoblja. Unatoč tim izazovima rezultati kliničkih studija pokazuju značajno poboljšanje u lokalnoj kontroli bolesti i smanjenju toksičnosti kod pacijenata s karcinomom prostate.
Budući razvoj adaptivne radioterapije uključuje integraciju umjetne inteligencije (AI) za automatsku segmentaciju i prilagodbu planova što bi moglo dodatno smanjiti vrijeme tretmana i povećati učinkovitost. Ova tehnologija uz podršku sve naprednijih hardverskih i softverskih rješenja ima potencijal postati standard u liječenju karcinoma prostate i drugih oblika raka pružajući pacijentima individualizirani pristup temeljen na specifičnostima njihove anatomije i biološkog odgovora na terapiju.This thesis analyzes the topic of adaptive radiotherapy as an advanced and innovative approach in the treatment of prostate cancer highlighting its advantages over conventional radiation techniques. Traditional radiotherapy methods often cannot account for daily anatomical changes in the patient which can result in suboptimal dose delivery and an increased risk of damage to healthy tissues and organs at risk. Adaptive radiotherapy addresses this issue by allowing the treatment plan to be adjusted during each session using advanced techniques such as multiparametric magnetic resonance imaging and MR-Linac technology.
The application of adaptive radiotherapy includes detailed contouring of the target volume and organs at risk based on daily imaging achieving greater precision in dose delivery and reducing adverse effects on surrounding healthy tissues. Compared to conventional techniques like 3D conformal radiation or intensity-modulated radiotherapy adaptive radiotherapy enables better monitoring and real-time adaptation of the treatment plan leading to significant clinical improvements.
The thesis also discusses the technical aspects of implementing adaptive radiotherapy including the use of advanced software solutions for plan optimization and dose calculation as well as the need for additional education for professional staff. Despite these challenges clinical studies show significant improvements in local disease control and reduced toxicity in prostate cancer patients.
The future development of adaptive radiotherapy involves the integration of artificial intelligence (AI) for automatic segmentation and plan adaptation which could further reduce treatment time and increase efficiency. This technology supported by increasingly advanced hardware and software solutions has the potential to become the standard in the treatment of prostate cancer and other forms of cancer providing patients with an individualized approach based on their anatomical and biological response to therapy
Advantages and disadvantages of a dual-source CT device
No full textKompjuterizirana tomografija vrsta je dijagnostičkog snimanja koja koristi rendgenske zrake za stvaranje slike. Prateći razvoj CT uređaja kroz generacije, veliki je fokus na kvalitetu slike, koja uvelike opada zbog prisutnosti artefakata koji su posljedica niza tehničkih faktora. Također, veliku prepreku predstavljala je i ukupna doza zračenja, koja je trebala pratiti ALARA načelo, temelj svih radioloških snimanja. Dvoizvorni CT uređaji najnovija su vrsta CT-a, a svoj princip rada temelji na istovremenoj rotaciji dvije rendgenske cijevi i detektora. Zahvaljujući tehnološkom napretku koji konstantno potiče nove izume u području radiologije, omogućeno je kraće vrijeme snimanja, bolja temporalna rezolucija, slike visokih kvaliteta i manje doze zračenja. Nekoć prepreke sada su dio prošlosti CT uređaja.Computed tomography is a type of diagnostic imaging that uses X-rays to create an image. Following the development of CT devices through the generations, there is a great focus on image quality, which greatly decreases due to the presence of artifacts that are the result of a number of technical factors. Also, the total radiation dose, which had to follow the ALARA principle, the basis of all radiological imaging, represented a major obstacle. Dual-source CT devices are the latest type of CT, and their principle of operation is based on the simultaneous rotation of two X-ray tubes and detectors. Thanks to technological progress that constantly encourages new inventions in the field of radiology, shorter scanning times, better temporal resolution, high-quality images and lower radiation doses are possible. Once obstacles are now a part of the past for CT scanners
The effect of ten-day physical therapy on functional indices, pain and range of motion in the patients with knee osteoarthritis
No full textTema ovog završnog rada je procijeniti utjecaj desetodnevne fizikalne terapije na funkcionalne indekse, bol, pokretljivost i mišićnu snagu kod pacijenata s osteoartritisom koljena.
U svrhu istraživanja provodila su se mjerenja i ispunjavanje funkcionalnih indeksa prije i nakon desetodnevnog ciklusa fizikalnih terapija. Za procjenu opsega pokreta korišten je goniometar, za procjenu mišićne snage manualno mišićni test (MMT) te je za procjenu boli korištena vizualno analogna skala (VAS). Za procjenu funkcionalnosti i stupnja ograničenja korišteni su Knee Injury and Osteoarthritis Outcome Score (KOOS) i Algofunctional index (AFI).
U istraživanju je sudjelovalo 20 pacijenata, od čega je bilo 6 osoba muškog spola, što čini 30% uzorka i 14 osoba ženskog spola, što čini 70% uzroka. Prosječna dob ispitanika iznosila je 67,96 ± 8,76.
Trenutna razina boli u koljenu smanjila se sa 5,3 ± 1,98 na 3,25 ± 1,65 nakon desetodnevne fizikalne terapije.
Razina boli u koljenu u posljednja 24 sata smanjila se s 5,25 ± 2,02 na 3,45 ± 1,9 nakon odrađene fizikalne terapije.
Najjača bolnost koljena u posljednjih tjedan dana smanjila se sa 6,2 ± 1,9 na 4,45 ± 2,03 nakon desetodnevne fizikalne terapije.
Najslabija razina boli u koljenu u posljednjih tjedan dana smanjila se sa 4,25 ± 2,29 na 2,3 ± 1,38 nakon desetodnevne fizikalne terapije.
Aktivna fleksija na početku terapije iznosila je 106,76 ± 16,96, dok je nakon provedene desetodnevne fizikalne terapije iznosila 113 ± 13,99.
Pasivne fleksija na početku terapije iznosila je 111,1 ± 15,64, dok se nakon provedene fizikalne terapije ta vrijednost povećala na 117,75 ± 11,97.
Aktivna ekstenzija na početku fizikalne terapije iznosila je 3 ± 4,12, dok se nakon provedene fizikalne terapije smanjila na 1,25 ± 2,22.
Pasivna ekstenzija na početku fizikalne terapije u prosjeku je iznosila 2,25 ± 4,12, dok se nakon provedene rehabilitacije ta vrijednost smanjila na 1 ± 2,05.
MMT fleksije povećan je s 2,85 ± 0,49 na 3,4 ± 0,5.
MMT ekstenzije povećan je s 3,15 ± 0,67 na 3,7 ± 0,47.
Funkcionalnost koljena mjerena KOOS upitnikom ispitana je u 5 kategorija:
Prosječna vrijednost kategorije simptomi i ukočenost povisila se 45,55 ± 20,87 na 58 ± 19,75 nakon deset dana fizikalne terapije.
Prosječna vrijednost u kategoriji bol povisila se s 50,15 ± 21,10 na 65,1 ± 18,11 nakon deset dana fizikalne terapije.
Prosječna vrijednost kategorije funkcioniranje u aktivnostima svakodnevnog života na početku fizikalne terapije iznosila je 52,70 ± 18,54 te se povisila na 62,25 ± 15,7 nakon deset dana fizikalne terapije.
Prosječna vrijednost funkcioniranja u sportskim i slobodnim aktivnostima na početku je iznosila 17,25 ± 22,97 te se povisila na 29,75 ± 22,90 nakon deset dana fizikalne terapije.
Prosječna vrijednost kategorije kvaliteta života prije odrađene fizikalne terapije iznosila je 31,6 ± 19,67 te se povisila na 33,45 ± 22,0 nakon deset dana fizikalne terapije.
Stupanj ograničenja funkcije mjeren AFI upitnikom smanjio se s 8,71 ± 3,54 na 7,17 ± 2,93 nakon desetodnevne fizikalne terapije.
Zaključak istraživanja je da desetodnevna fizikalna terapija poboljšava kretnje i mišićnu snagu te smanjuje bolnost koljena u pacijenata s osteoartritisom. Također je iz rezultata vidljivo kako povećava funkcionalnost osobe i smanjuje stupanj ograničenja funkcije.The topic of this final paper is to evaluate the impact of ten days of physical therapy on functional indices, pain, mobility and muscle strength in patients with knee osteoarthritis.
For the purpose of the research, measurements and completion of functional indices were carried out before and after the ten-day cycle of physical therapy. A goniometer was used to assess the range of motion, a manual muscle test (MMT) was used to assess muscle strength, and a visual analog scale (VAS) was used to assess pain. The Knee Injury and Osteoarthritis Outcome Score (KOOS) and Algofunctional index (AFI) were used to assess functionality and degree of limitation.
20 patients participated in the research, of which 6 were male, which makes up 30% of the sample, and 14 were female, which makes up 70% of the cause. The average age of the respondents was 67.96±8.76.
The current level of knee pain decreased from 5.3 ± 1.98 to 3.25 ± 1.65 after ten days of physical therapy.
The level of knee pain in the last 24 hours decreased from 5.25 ± 2.02 to 3.45 ± 1.9 after physical therapy.
Passive extension at the beginning of physical therapy averaged 2.25 ± 4.12, while after the rehabilitation this value decreased to 1 ± 2.05.
Flexion MMT increased from 2.85 ± 0.49 to 3.4 ± 0.5.
MMT of extension increased from 3.15 ± 0.67 to 3.7 ± 0.47.
Knee functionality measured by the KOOS questionnaire was examined in five categories:
The average value of the symptoms and stiffness category increased from 45.55 ± 20.87 to 58 ± 19.75 after ten days of physical therapy.
The average value in the pain category increased from 50.15 ± 21.10 to 65.1 ± 18.11 after ten days of physical therapy.
The average value of the category functioning in daily life activities at the beginning of physical therapy was 52.70 ± 18.54 and increased to 62.25 ± 15.7 after ten days of physical therapy.
The average value of functioning in sports and leisure activities at the beginning was 17.25 ± 22.97 and increased to 29.75 ± 22.90 after ten days of physical therapy.
The average value of the quality of life category before physical therapy was 31.6 ± 19.67 and increased to 33.45 ± 22.0 after ten days of physical therapy.
The degree of function limitation measured by the AFI questionnaire decreased from 8.71 ± 3.54 to 7.17 ± 2.93 after ten days of physical therapy.
The conclusion of the research is that ten-day physical therapy improves movement and muscle strength and reduces knee pain in patients with osteoarthritis. It is also evident from the results that it increases a person's functionality and reduces the degree of functional limitation
The role of MR perfusion in the differentiation of pelvic tumors
No full textMagnetna rezonancija jedna je od najznačajnijih dijagnostičkih uređaja današnjice. MR se često koristi za dijagnosticiranje različitih stanja, uključujući tumore, ozljede, neurološke poremećaje, bolesti zglobova i mišića, srčane probleme i još mnogo toga. Također se može koristiti za praćenje napretka bolesti i učinkovitosti liječenja. Slike dobivamo pomoću korištenja različitih MR sekvenci koje su kombinacija različitih parametara. Jedna od bitnijih tehnika koju koristimo u radiologiji je upravo MR perfuzija. Dokazala se kao jako korisna tehnika i odličan alat za detekciju različitih bolesti, tumora ili vaskularnih poremećaja. MR je izvrsna metoda za procjenu zdjelice. Izvrstan kontrast mekog tkiva, osjetljivost za detekciju tekućine i multiplanarne mogućnosti snimanja MR-om omogućuju neinvazivno prikazivanje normalne anatomije i patoloških procesa.Magnetic resonance is one of the most important diagnostic devices today. MRI is often used to diagnose a variety of conditions, including tumors, injuries, neurological disorders, joint and muscle diseases, heart problems, and more. It can also be used to monitor disease progress and treatment effectiveness. We obtain images by using different MR sequences that are combinations of different parameters. One of the most important techniques we use in radiology is MR perfusion. It has proven to be a very useful technique and an excellent tool for detecting various diseases, tumors or vascular problems. MR is an excellent method for evaluating the pelvis. Excellent soft tissue contrast, sensitivity for fluid detection, and multiplanar MR imaging capabilities enable noninvasive imaging of normal anatomy and pathological processes
Nursing procedures in patients with spleen rupture
No full textRuptura slezene je ozbiljno medicinsko stanje koje zahtijeva hitnu intervenciju zbog potencijalno opasnih posljedica, uključujući unutarnje krvarenje i šok. Ova ozljeda najčešće nastaje uslijed trauma abdomena, poput prometnih nesreća ili sportskih povreda, ali može biti i posljedica određenih bolesti koje slabe tkivo slezene. Klinička slika rupture slezene obuhvaća simptome poput nagle boli u lijevom gornjem kvadrantu abdomena, hipotenzije, tahikardije i znakova hipovolemijskog šoka. Brza dijagnostika, ključna je za potvrđivanje dijagnoze i procjenu ozbiljnosti ozljede. Liječenje rupture slezene može biti konzervativno ili kirurško, ovisno o težini ozljede i hemodinamskoj stabilnosti bolesnika. Konzervativno liječenje uključuje strogi nadzor u jedinici intenzivnog liječenja, redovito praćenje vitalnih parametara i osiguranje adekvatne hidratacije i prehrane. Medicinske sestre imaju važnu ulogu u skrbi za bolesnike s rupturom slezene, od hitne intervencije do poslijeoperacijske rehabilitacije. Postupci medicinske sestre uključuju brzu evaluaciju simptoma, pripremu bolesnika za dijagnostičke pretrage i kirurške zahvate, te kontinuirano praćenje vitalnih znakova i hemodinamskog statusa. Njihova uloga u planiranju i implementaciji individualiziranih planova zdravstvene njege, kontinuiranom praćenju stanja bolesnika i pružanju edukacije i podrške neophodna je za uspješan oporavak i kvalitetan život bolesnika s rupturom slezene.A ruptured spleen is a serious medical condition that requires immediate intervention due to potentially dangerous consequences, including internal bleeding and shock. This injury most often occurs as a result of trauma to the abdomen, such as traffic accidents or sports injuries, but it can also be the result of certain diseases that weaken the spleen tissue. The clinical picture of splenic rupture includes symptoms such as sudden pain in the left upper quadrant of the abdomen, hypotension, tachycardia and signs of hypovolemic shock. Rapid diagnosis is essential for confirming the diagnosis and assessing the severity of the injury. Treatment of splenic rupture can be conservative or surgical, depending on the severity of the injury and the hemodynamic stability of the patient. Conservative treatment includes strict monitoring in the intensive care unit, regular monitoring of vital parameters and ensuring adequate hydration and nutrition. Nurses play an important role in the care of patients with ruptured spleen, from emergency intervention to postoperative rehabilitation. The nurse's procedures include rapid evaluation of symptoms, preparation of patients for diagnostic tests and surgical procedures, and continuous monitoring of vital signs and hemodynamic status. Their role in planning and implementing individualized health care plans, continuous monitoring of the patient's condition and providing education and support is necessary for the successful recovery and quality of life of patients with a ruptured spleen
Knowledge about cardiovascular diseases and their prevention in Split-Dalmatia County
No full textUvod: Kardiovaskularne bolesti su bolesti srca i krvnih žila te su jedne od vodećih globalnih uzroka mortaliteta i
morbiditeta u svijetu te time predstavljaju jedan od najvećih javnozdravstvenih problema na svijetu.
Cilj: Utvrditi znanje, stavove i percepciju opće odrasle populacije o kardiovaskularnim bolestima, njihovim rizičnim
čimbenicima te kako kardiovaskularne bolesti utječu na kvalitetu života.
Metode: Istraživanje je provedeno na 393 ispitanika preko anonimnog online obrasca u Splitsko-dalmatinskoj županiji.
Upitnik se sastoji od sociodemografskog upitnika i ABCD upitnika. Istraživanje se provodilo od 1. svibnja 2023. do
17. svibnja 2023. godine.
Rezultati: U istraživanju je sudjelovalo 2,28 puta više žena nego muškaraca. Prosječna dob ispitanika je 33 godine.
Srednja tjelesna težina ispitanika je 74 kg. Prosječna razina znanja ispitanika o kardiovaskularnim bolestima je 71,28%.
Ukupna razina percepcije od srčanog/moždanog udara je 16,91 što ukazuje na umjerenu razinu percipiranog rizika od
srčanog/moždanog udara među ispitanicima. Ukupna razina percipirane koristi i namjere za promjenom je 2,97 što
ukazuje na visoku razinu percepcije koristi i namjere za promjenom među ispitanicima. Razina namjere za zdravom
prehranom je 2,58 među ispitanicima što predstavlja srednju razinu namjere za zdravom prehranom među ispitanicima.
Cronbach α validiranog ABCD upitnika rizika iznosi 0,538, a vrijednosti za svaki faktor iznose: znanje (0,54),
percipiran rizik od srčanog/moždanog udara (0,84), percipirane koristi i namjere za promjenom (0,89) i namjere za
zdravom prehranom (0,72).
Zaključak: Hrvatska verzija ABCD – upitnika rizika ima zadovoljavajuće mjerne karakteristike za procjenu znanja,
stavova i vjerovanja o kardiovaskularnim bolestima. Stupanj obrazovanja je u pozitivnoj vezi sa znanjem i stavovima
o kardiovaskularnim. Postoji korelacija između fizičke aktivnosti, prehrambenih navika, obiteljske dispozicije, stresa
i štetnih ponašanja u odnosu na kardiovaskularne bolesti.Introduction: Cardiovascular diseases are diseases of the heart and blood vessels and are one of the leading global
causes of mortality and morbidity in the world, thus representing one of the biggest public health problems in the
world.
Aim: To determine the knowledge, attitudes and perception of the general adult population about cardiovascular
diseases, their risk factors and how cardiovascular diseases affect the quality of life.
Methods: The research was conducted on 393 respondents via an anonymous online form in Split-Dalmatia County.
The questionnaire consists of a sociodemographic questionnaire and an ABCD questionnaire. The research was
conducted from May 1, 2023 to May 17, 2023.
Results: 2.28 times more women than men participated in the research. The average age of the respondents is 33 years.
The average body weight of the subjects is 74 kg. The average level of knowledge of the respondents about
cardiovascular diseases is 71.28%. The overall level of perception of heart/stroke is 16.91, which indicates a moderate
level of perceived risk of heart/stroke among the respondents. The overall level of perceived benefit and intention to
change is 2.97, which indicates a high level of perceived benefit and intention to change among respondents. The level
of intention to eat healthy is 2.58 among respondents, which represents the average level of intention to eat healthy
among respondents. Cronbach α of the validated ABCD risk questionnaire is 0.538, and the values for each factor are:
knowledge (0.54), perceived risk of heart attack/stroke (0.84), perceived benefits and intentions to change (0.89) and
intentions to healthy diet (0.72).
Conclusion: The Croatian version of the ABCD - risk questionnaire has satisfactory measurement characteristics for
the assessment of knowledge, attitudes and beliefs about cardiovascular diseases. Level of education is positively
related to knowledge and attitudes about cardiovascular. There is a correlation between physical activity, eating habits,
family disposition, stress and harmful behaviours in relation to cardiovascular diseases
Determination of methods for selecting target volumes in daily work during radical treatment of prostate cancer
No full textUvod: Komplikacije liječenja raka prostate (RP), kao najčešće zloćudne novotvorine muškaraca u razvijenom dijelu svijeta, predstavljaju značajan javnozdravstveni problem. Nakon radikalne radioterapije, kasni neželjeni učinci ovise o nizu čimbenika, a među osobito bitnima je veličina ozračenog kliničkog ciljnog volumena (CTV). Unatoč toj činjenici, ne postoji jednoobrazni, standardizirani i opće prihvaćeni postupak za određivanje CTV-a.
Cilj: Istraživanjem se pokušalo utvrditi metodu određivanja CTV-a pri radikalnoj radioterapiji RP u svakodnevnoj kliničkoj praksi.
Ispitanici i metode: U istraživanje, koje je obuhvatilo period od 2020. do 2022., bilo je uključeno 210 bolesnika s lokaliziranim adenokarcinomom prostate koji su radikalno zračeni u Klinici za tumore, u KBC Sestre milosrdnice, u Zagrebu. Opaženi odabir CTV-a uspoređivan je sa CTV-ima koji su za svakog pojedinog bolesnika određivani primjenom metoda predloženih u stručnoj literaturi: pripadnost rizičnoj skupini, Roachov matematički model, nomogram Memorijalnog centra za rak Sloan Kettering (MSKCC) i Smjernice hrvatskih stručnih društava.
Rezultati: Medijan dobi uključenih bolesnika iznosio je 75 godina, s rasponom od 54 do 87 godina. Bolest niskog rizika imalo je 3,8% bolesnika, srednjeg rizika 69,5% bolesnika i visokog rizika 26,7% bolesnika. Opaženi CTV je kod 21% bolesnika uključivao samo prostatu, kod 50% bolesnika prostatu i sjemenske mjehuriće te kod 29% prostatu, sjemenske mjehuriće i zdjelične limfne čvorove. Opažena raspodjela CTV-a statistički se značajno razlikovala od CTV-a određenih temeljem rizičnih skupina (p=0,0396), temeljem Roachovog matematičkog modela (p=0,0023), temeljem MSKCC nomograma (p=0,0005) i temeljem Smjernica hrvatskih stručnih društava (p=0,0012). Statistički značajne razlike nema između CTV-a određenih na bazi Smjernica hrvatskih stručnih društava i na bazi MSKCC nomograma. Statistički granično značajna razlika postoji između CTV-a definiranih prema rizičnim skupinama i prema Roachovim jednadžbama. Između svih drugih preporučenih CTV-a postoji statistički značajna razlika. Opaženi i preporučeni CTV-i međusobno pozitivno koreliraju i pokazuju slične trendove.
Rasprava: Istraživanjem je utvrđeno da su opaženi CTV-i odabirani nejednolikim pristupom. Izgled violinskog grafa upućuje da se odlučivanje većinski temeljilo na rizičnim skupinama. Visoka korelacija pokazuje da su se kao nadopuna rizičnim skupinama koristili MSKCC nomogrami i Smjernice hrvatskih stručnih društava.
Zaključak: Istraživanjem je zapaženo da određivanje CTV-a u kliničkoj praksi nije jednoobrazno što bi bio uvjet za postavljanje na nacionalnu razinu nego je prilagođeno normama svakog bolničkog centra posebno.Introduction: Complications of prostate cancer (PC) treatment, the most common malignant neoplasm in men in the developed world, present a significant public health issue. Following radical radiotherapy, late adverse effects depend on various factors, with the size of the irradiated clinical target volume (CTV) being particularly crucial. Despite this, there is currently no unified, standardized, and universally accepted procedure for determining the CTV.
Aim: The study aimed to determine methods for defining the CTV in radical radiotherapy for PC in routine clinical practice.
Patients and Methods: The study, conducted from 2020 to 2022, included 210 patients with localized adenocarcinoma of the prostate who underwent radical radiation therapy at the University Hospital for Tumors, University Hospital centar of Sisters of Mercy in Zagreb, Croatia. The observed selection of CTV was compared with CTVs determined for each patient using methods proposed in the literature: membership in risk groups, Roach's mathematical model, Memorial Sloan Kettering Cancer Center (MSKCC) nomogram, and Croatian Society for Oncology.
Results: The median age of the patients was 75 years, ranging from 54 to 87 years. Low-risk disease was observed in 3.8% of patients, intermediate-risk in 69.5%, and high-risk in 26.7%. The observed CTV included only the prostate in 21% of patients, the prostate and seminal vesicles in 50%, and the prostate, seminal vesicles, and pelvic lymph nodes in 29%. The observed distribution of CTV significantly differed from CTVs determined based on risk groups (p=0.0396), Roach's model (p=0.0023), MSKCC nomogram (p=0.0005), and Croatian Society for Oncology (p=0.0012). There were no statistically significant differences between CTVs determined based on Croatian Society guidelines and MSKCC nomogram. A statistically borderline significant difference existed between CTVs defined according to risk groups and Roach's equations. There was a statistically significant difference between all other recommended CTVs. Observed and recommended CTVs positively correlated with each other and exhibited similar trends.
Discussion: The study found that observed CTVs were selected with a non-uniform approach. The appearance of the violin plot suggests that decision-making was predominantly based on risk groups. High correlation indicates that MSKCC nomograms and Croatian Society guidelines were used as complementary tools alongside risk groups.
Conclusion: The study observed that CTV determination in clinical practice is not standardized, which would be a prerequisite for national-level implementation, but rather tailored to the norms of each hospital center individually