University Department of Health Studies Repository
Not a member yet
1537 research outputs found
Sort by
Children and family coping with children's malignant disease
No full textMaligna bolest, poznata još i pod nazivom rak, označava nekontroliranu i abnormalnu proliferaciju stanica u ljudskom tijelu. Nažalost, ona se može pojaviti u svim razdobljima života, pa tako i kod djece i adolescenata. Na koji način će utjecati na njihove živote, najvećim dijelom ovisi o razvojnoj fazi u kojoj se dijete nalazi. Razvojne faze opisao je psiholog Jean Piaget, a u svakom se razdoblju ističu neke značajne karakteristike. Maligna bolest je situacija s kojom se moraju suočiti i roditelji djeteta te braća i sestre, a svaki se pojedinac može suočavati na različiti način. Budući da je maligna bolest ujedno i kronična bolest, ona ugrožava kvalitetu života oboljelog djeteta i njegovih članova obitelji kroz dulji period. Uz sve to, zloćudne bolesti gotovo uvijek zahtijevaju hospitalizaciju. Tijekom boravka na pedijatrijskom onkološkom odijelu, dijete se susreće s brojnim medicinskim osobljem, ali upravo su medicinske sestre i tehničari oni koji najviše vremena provode uz dijete. Iz toga proizlazi važnost njihovog rada u skladu s etičkim i moralnim načelima te kompetencijama. Hospitalizacija je dodatan stres za dijete i obitelj, stoga je vrlo važno malom pacijentu, ali i obitelji pristupiti holistički i pružiti adekvatnu zdravstvenu njegu, uz istodobno razvijanje povjerenja i komunikacije, jer je to ključ uspjeha rada medicinskih sestara, a pozitivno utječe na sučeljavanje sa stanjem kao što je maligna bolest.Malignant disease, also known as cancer, means uncontrolled and abnormal cell proliferation in the human body. Unfortunately, it can occur at all stages of life, including children and adolescents. How it will affect their lives largely depends on the developmental stage of life. The developmental stages were described by the psychologist Jean Piaget, and there are some significant characteristics of every stage. Malignant disease is a situation that must be faced by the child's parents and siblings, and each individual can face it differently. Since malignant disease is also a chronic disease, it threatens the quality of life of a sick child and his family members over a long time. In addition to all this, malignant diseases almost always require hospitalization. During the stay in the pediatric oncology ward, the child meets a great number of medical staff, but it is the nurses and technicians who spend the most time with the child. Iti s the reason why is so important to work in accordance with ethical and moral principles and under their competencies of work. Hospitalization is an additional stress for the child and family, so it is very important to approach the pediatric patient and family holistically and provide adequate health care, while developing trust and communication, because it is the key to success of nurses work and it positively affects coping with the situation such as malignant disease
REQUIREMENTS OF GERIATRIC POPULATION FOR EMERGENCY MEDICINE DEPARTMENT OF SDC IN YEAR BEFORE COVID-19 PANDEMIC AND IN YEAR OF COVID-19 PANDEMIC
No full textCilj: Cilj rada je istražiti učestalost potreba gerijatrijske populacije za Zavodom za hitnu medicinu Splitsko-dalmatinske županije (ZHM SDŽ), gledano kroz prijemne dijagnoze u godini prije pandemije COVID-19 i u godini pandemije COVID-19.
Materijali i metode: U ovo retrospektivno istraživanje uključeni su svi pacijenti od 65 godina i stariji u Zavodu za hitnu medicinu Splitsko-dalmatinske županije (ZHM SDŽ) od veljače 2019. do veljače 2021. godine. Podaci o dobi, spolu te prijemnoj dijagnozi pacijenata prema MKB-10 klasifikaciji prikupljeni su iz računalnog programa „e-Hitna“.
Rezultati: Potreba za zdravstvenim intervencijama Zavoda za hitnu medicinu SDŽ-a je smanjena za 23,45% u 2020. godini u odnosu na 2019. godinu. Ispitivanjem je utvrđeno kako je riječ o statistički značajno manjem broju intervencija u pandemijskoj 2020. godini u odnosu na pretpandemijsku 2019. godinu (χ2=1492,72; P<0,001). Kod oba spola je utvrđeno smanjenje broja pacijenata. Među svim dobnim skupinama veći je broj pacijenata u 2019. godini u odnosu na 2020. godinu. Prema MKB opisu potreba je utvrđen pad svih vrsta dijagnostičkih potreba izuzev U00-U99 gdje je utvrđen porast sa 0 na 584 pacijenta, te dijagnostičkih potreba G00-G99 kod kojih nije utvrđena statistički značajna promjena (χ2=1,29; P=0,257) dok je najveći pad utvrđen kod dijagnostičke potrebe V01-V99 koje za razliku od 2019. godine nisu utvrđene u 2020. godini (p<0,001).
Zaključci: Potreba za intervencijama ZHM SDŽ se promijenila s obzirom na zadano razdoblje prije i za vrijeme pandemije. U godini pandemije muškaraca je manje za 20,7%, dok je pad kod žena 26,2%, s obzirom na godinu prije. Prema tri dobne skupine starijih osoba (65-74, 75-84, 85 i više godina) najveći pad je zabilježen kod dobne skupine 65-74 godine. Prema MKB-10 klasifikaciji bolesti, u godini pandemije bilježi se pad broja zastupljenosti u svim razredima dijagnoza s obzirom na prethodnu godinu, izuzev U00-U99 gdje je utvrđen porast na 584 pacijenta.Objective: The aim of this paper is to explore the frequency of requirements of geriatric population for Emergency Medicine Department of SDC from the perspective of diagnosis in year before COVID-19 pandemic and in year of COVID-19 pandemic.
Materials and methods: This retrospective study included all patients treated at the Emergency Medicine Department from February 2019 to February 2021. Data on age, sex and diagnosis of patients by ICD-10 classification were collected from medical software „e-Hitna“.
Results: The need for medical interventions in Emergency Medicine Department of SDC is reduced by 23,45% in year 2020. compared to 2019. It was determined by this study that the decrease in the number of interventions is statistically significant (χ2=1492,72; P<0,001). The deacrease in the number of patients is determined in both sexes and among all age groups. By ICD-10 classification, the number of all diagnostic needs has been reduced, except U00-U99 where the increase from 0 to 584 patients is determined and G00-G99 where no statistically significant change has occurred (χ2=1,29; P=0,257). Largest decrease has appeared in group V01-V99 where diagnostic needs didn't occurre at all in year 2020. as opposed to 2019.
Conclusions: The need for medical interventions in Emergency Medicine Department of SDC has changed in the given period before and during pandemic. Number of male patients is reduced by 20,7% and female patients by 26,2% in year of pandemic as opposed to year before. Among all age groups (65-74, 75-84, 85 and older), the largest decrease has occurred in age group 65-74. By ICD-10 classification, the number of diagnostic needs has decreased in all diagnosis groups in the year 2020. as opposed to 2019., except group U00-U99 where the increase of 584 patients has occurre
Heatlh care of the patients after tonsil surgery
No full textOperacija tonzila jedan je od najčešćih zahvata na svijetu, u otorinolaringologiji, ali i u dječjoj kirurgiji uopće. Osnovni princip operativnog zahvata nije se mijenjao od davnih dana, nego su se samo mijenjale tehnike i instrumenti. Naizgled nezahtjevan zahvat može postati problematičan radi poslijeoperacijskog krvarenja, boli, ali i infekcije. Kod većine operacijskih zahvata rana se primarno zatvara dok zahvat na tonzilama završava otvorenom ranom te je zbog toga potrebno prilagoditi prehranu pacijenta kako bi se izbjegle infekcije i dodatno krvarenje. Od apsolutnih indikacija za operaciju najvažnija je ona kada pacijent ima više od 5 epizoda upale grla godišnje. Od relativnih indikacija za operaciju možemo reći da je jedna od najvažnijih kada pacijent pati od kroničnog tonzilitisa, kronične globolje i lošeg zadaha u periodu od godine dana. Medicinska sestra ima jako važnu ulogu u sprečavanju komplikacija uzrokovanih zahvatom, ali i pravovremenom prepoznavanju lakših i težih komplikacija. Medicinska sestra je uvijek uz pacijenta, pa čak i kada liječnik nije te pruža psihofizičku pomoć prije i poslije operacije. Izrađuje plan zdravstvene njege sa svim pacijentovim dijagnozama te na kraju evaluira učinjene zadatke. Edukacijom pacijenta o životnim navikama poslije operacije osigurava zadovoljavajućukvalitetu života.Tonsil surgery is one of the most common procedures in the world, in otolaryngology, but also in pediatric surgery in general. The basic principle of surgery has not changed since long ago, only techniques and instruments have changed. A seemingly undemanding procedure can become problematic due to postoperative bleeding, pain, and infection. In most surgical procedures, the wound is primarily closed, while the procedure on the tonsils ends with an open wound, and therefore it is necessary to adjustthe patient's diet to avoid infections and additional bleeding. Of the absolute indications for surgery, the most important is when the patient has more than 5 episodes of sore throat per year. Of the relative indications for surgery, we can say that one of the most important is when the patient suffers from chronictonsillitis, chronic sore throat and bad breath for a period of one year. The nurse has a very important role in preventing complications caused by the procedure, but also in timely recognition of minor and severe complications. The nurse is always with the patient, even when the doctor is not, and provides psychophysical assistance before and after surgery. Creates a health care plan with all the patient's diagnoses and at the end evaluates the completed tasks. Educating the patient about life habits after surgery ensures a satisfactory quality of life
Ethical issues in healthcare
No full textSestrinstvo se percipira kao etička struka od samih početaka. Tijekom vremena je neminovno došlo do
promjene percepcije etike i etičnosti. Danas se sestra smatra zagovornicom pacijenta (engl. patient advocate) koja
pomaže pacijentima kod donošenja kompleksnih odluka. Medicinska sestra i sama nastoji etički postupati u
svakodnevnim kliničkim situacijama. Napredak dijagnostike i terapije u medicini je omogućio bolji i kvalitetniji
oporavak pacijenata i produljenje životnoga vijeka. Posljedično svekolikom napretku medicine dolazi i do sve
učestalijih moralnih i etičkih dvojbi vezanih za pacijentov integritet, boljitak, kvalitetu i cijenu zdravstvene skrbi. Iako
se uglavnom općenito zna ili nagađa o postojanju etičke problematike ista nije sistematski istražena i to prvenstveno u
smislu vrste i učestalosti. Glavni cilj ovog rada je utvrditi vrstu i pojavnost etičkih problema medicinskih
sestara/tehničara te korelirati povezanost etičkih problema s godinama staža u struci, vrstom struke i spolom. U KBCu Split je provedeno presječno istraživanje (engl. cross-sectional study) koje je uključivalo medicinske sestre i
tehničare zaposlene u KBC-u a koji su bili voljni sudjelovati u istraživanju i ispuniti upitnik etičkih dvojbi. U
istraživanju je korišten obrazac za upis demografskih podataka i upitnik Skala etičkih problema(dvojbi) (engl. Ethical
Issues Scale). U ovom istraživanju je potvrđeno postojanje etičkih problema ispitanika. Najčešći etički problemi su iz
domene ljudskih prava. Rezultati ovog istraživanja su u suglasju sa rezultatima etičkih istraživanja iz razvijenih država.
Nije potvrđena korelacija rezultata s trajanjem radnog staža, dobi i spolom ispitanika. Iako se općenito zna o postojanju
etičkih problema sestara isti nisu sistematski istraženi kako u našoj državi tako i u svijetu. Identifikacija etičkih
problema je put ka efikasnom rješavanju istih jer neriješeni etički problemi negativno utječu na produktivnost. Etički
problemi ovise o individualnom, ali i o organizacijskom aspektu zdravstvenog radnika i zdravstvene ustanove. Najčešći
etički problemi medicinskih sestara i tehničara koji su sudjelovali u ovom istraživanju su iz domene problematike u
svezi s ljudskim pravima. Takvi rezultati su u suglasju s publiciranim istraživanjima razvijenih država. Temeljem ovih
rezultata postoji konkretna osnova za rješavanje tj. ublažavanje etičke problematike.Nursing has been perceived as an ethical profession since its inception. Over time, the perception of
ethics inevitably changed. Today, a nurse is considered a patient advocate who helps patients make complex decisions.
Nurse tries to act ethically in everyday clinical situations. Advances in diagnostics and therapy in medicine have
enabled better recovery of patients and prolongation of life expectancy. As a result, with the progress of medicine,
there are much more moral and ethical doubts related to the patient's integrity, well-being, quality and cost of health
care, etc. Although it is generally known about the existence of ethical problems it has not been systematically
investigated, primarily in terms of type and frequency. The main goal of this work is to determine the type and
occurrence of ethical problems of nurses/technicians. Also we wanted to correlate the relationship between ethical
problems and years of experience in the profession, type of profession and gender. A cross-sectional study was
conducted at University hospital Split, which included nurses and technicians employed at KBC who were willing to
participate in the research and fill the Ethical Issues Scale questionnaire. The research used a form for entering
demographic data and the Ethical Issues Scale questionnaire. In this research, the existence of ethical problems of the
nurses was confirmed. The most common ethical problems are from the domain of human rights. The results of this
research are in agreement with the results of ethical research from developed countries. The correlation of the results
with the length of service, age and gender of the respondents was not confirmed. Although it is generally known about
the existence of ethical problems of nurses, they have not been systematically investigated both in our country and in
the world. Identification of ethical problems is the way to their efficient solution. Ethical problems depend on the
individual but also on the organizational aspect of the health worker and the health institution. The most common
ethical problems of nurses and technicians who participated in this research are from the domain of issues related to
human rights. Such results are in agreement with published studies of developed countries. Based on these results,
there is a concrete basis for solving, i.e. mitigating, ethical issues
Midwifery care of newbam infants on invasive and non-invasive ventilation in neonatal intesive care units
No full textPrimalje su neizostavan ĉlan tima u procesu lijeĉenja novoroĊenoga djeteta. One svojim
struĉnim pristupom, znanjem i vještinama iznimno utjeĉu na bolju i kvalitetniju skrb za novoroĊenĉad.
Jedan od glavnih razloga dolaska novoroĊenĉadi u jedinicu intenzivnog lijeĉenja je upravo problem sa
disanjem. Iznimno je vaţno pravodobno uoĉiti kliniĉke simptome kako bi se moglo adekvatno reagirati.
UreĊaji za strojnu ventilaciju mogu biti invazivni (konvencionalni) i neinvazivni (nekonvencionalni).
Strojna ventilacija je indicirana ukoliko novoroĊenĉe nema pravilan ritam disanja ili nije u mogućnosti
samostalno disati. Uloga primalje u njezi novoroĊenĉeta koje je strojno ventilirano je široka i iznimno
vaţna. Ona je neizostavan ĉlan tima koji kontinuirano skrbi o novoroĊenĉetu. Primalja je duţna pratiti i
dokumentirati sve promjene koje se dogaĊaju kod novoroĊenĉeta te o tome obavijestiti lijeĉnika.Midwives are an indispensable part of the team in the process of treating a newborn child.
With their expertise, knowledge and skills, they greatly contribute to better and higher quality of care for
the newborns. One of the main reasons for the admission of newborns in the intensive care unit is in fact
the problem with breathing. It is extremely important to spot clinical symptoms in a timely manner in
order to respond appropriately. Mechanical ventilation devices can be invasive (conventional) and noninvasive (unconventional). Mechanical ventilation is indicated if the newborn does not have a proper
breathing rhythm or is unable to breathe. The role of midwives in caring for a mechanically ventilated
newborn is broad and extremely important. She is an indispensable member of the team that continuously
takes care of the newborn. The midwife is obliged to monitor and document all changes that occur in the
newborn and inform the doctor about i
CONTRAST MAMMOGRAPHY
No full textMamografija je probirna metoda otkrivanja karcinoma dojke. Razvojem medicinske znanosti i moderne tehnologije, u zdravstveni se sustav uvodi i nova digitalna metoda pod nazivom kontrastna mamografija. Utemeljena je na oslikavanju tkiva dojke korištenjem kontrastnoga sredstva i dual – energy tehnike. Rekombinacijom slika visoke i niske energije dobiju se dvostruke slike : jedna slika niske energije koja odgovara klasičnom mamografskom pregledu, a druga, rekombinirana slika s istaknutom lezijom obojanom kontrastom. Kontrastna mamografija omogućava preciznije isticanje novih, benignih ili malignih tvorbi. S obzirom na visoku osjetljivost ove metode, često se koristi kao zamjena ili nadopuna MR dijagnostici i 3D mamografiji. S obzirom da se tek uvodi u zdravstvene ustanove, postoji vjerojatnost za dodatnim ispitivanjem kakvoće ove metode.Mammography is a screening method for detecting breast cancer. With the development of medical science and modern technology, a new digital method called contrast mammography is being introduced into the healthcare system. It is based on breast tissue imaging using a contrast agent and dual - energy technique. Recombination of high and low energy images produce dual images: one low energy image corresponding to classical mammographic examination, and the other, a recombined image with a prominent contrast - stained lesion. Contrast mammography enables more precise highlighting of new, benign or malignant formations. Due to the high sensitivity of this method, it is often used as a replacement or supplement to MR diagnostics and 3D mammography. Since it is just being introduced in healthcare facilities, there is a possibility testing the quality of this method more prominently
Laboratory diagnosis in Covid-19 patients
No full textCilj istraživanja: istražiti da li je moguće uz pomoć analiziranih laboratorijskih parametara predvidjeti tijek i ishod bolesti COVID 19 kod starije populacije.
Ispitanici i metode: Ispitanici su 32 osobe hospitalizirane u jedinici intezivne njege KBC Split radi COVID-19 infekcije preko 60 godina starosti od kojih je 8 preživljelih i 8 preminulih muškaraca te 8 preživljelih i 8 preminulih žena. Venepunkcija uzoraka seruma izvršila se u okviru standardnog uzorkovanja krvi u skladu s Nacionalnim preporukama za uzorkovanje venske krvi (Hrvatsko društvo za medicinsku biokemiju i laboratorijsku medicinu (HDMBLM) iz ožujka 2014.godine). Razine vitamina D analizirane su imunokemijskom elektrokemoluminiscentnom metodom proizvođača Roche na analizatoru Cobas e801. Razine kalcija, magnezija i fosfora analizirane su spektrofotometrijskom metodom proizvođača Roche na analizatoru Cobas c702. Broj leukocita, limfocita, neutrofilnih granulocita te trombocita su određeni na multiparametarskom hematološkom analizatoru, Advia 2120, za dijagnostiku in vitro u kliničkim laboratorijima. Pozitivan rezultat na virus SARS-Cov-2 je dokazan molekularnom PCR metodom.
Rezultati: Napravljena je usporedba razine vitamina D u skupini osoba koje su preživjele u odnosu na skupinu umrlih osoba od posljedica COVID-19 bolesti te nije uočena statistička značajnost, preživjeli vs umrli (44.0 ± 29.7 vs 36.1 ± 18.3), p=0.376. Ono što se primjećuje je kako obje skupine imaju sniženu razinu vitamina D u serumu. Svim uključenim pacijentima je napravljena krvna slika, razina kalcija, magnezija i fosfora u serumu. Uočavamo najveću statističku značajnost kod omjera neutrofila i limfocita p=0.002, te da dob osobe utječe na ishod bolesti p=0.032 kao i ukupni broj leukocita p=0.028 i razina kalcija p=0.028. Izmjerene razine vitamina D u korelaciji s analiziranim laboratorijskim parametrima nisu pokazale međuzavisnost odnosno nema poveznice između razine vitamina D i broja leukocita, neutrofilnih granulocita, limfocita, trombocita, neutrofilno-limfocitnog omjera, trombocitno-limfocitnog omjera, kalcija, fosfora i magnezija. Multivarijabilna logistička regresijska analiza pokazala je da je samo broj leukocita statistički značajan prediktor preživljenja COVID-19 bolesti (OR 1.570, 95% CI 1.016 - 2.427; p = 0.041) kada se stavi u model zajedno s osnovnim karakteristikama poput dobi i spola te s drugim osnovnim laboratorijskim parametrima (OR 1.570, 95% CI 1.016 - 2.427; p = 0.041).
Zaključak: Ishod bolesti COVID-19 kod istraživane populacije je lošiji što je dob starija te je još veći rizik uz visoki ukupan broj leukocita. Razina vitamina D je niska u proučavanoj skupini ali ne utječe na ishod bolesti i nema prognostički značaj. Neutrofilno-limfocitni omjer je prediktor tijeka COVID-19 bolesti te bi ga trebalo uzeti u obzir kod primjene terapije u liječenju.Objectives: Investigate is it possible to predict the course and outcome of COVID-19 disease in the elderly population with the help of analyzed laboratory parameters
Subjects and methods: Respondents were 32 people hospitalized in the intensive care unit of KBC Split due to COVID-19 infection over 60 years of age, of which 8 survivors and 8 deceased men and 8 survivors and 8 deceased women. Venepuncture of serum samples was performed as part of standard blood sampling in accordance with the National Recommendations for Venous Blood Sampling (Croatian Society for Medical Biochemistry and Laboratory Medicine (HDMBLM) from March 2014). Vitamin D levels were analyzed by Roche immunochemical electrochemoluminescent method on a Cobas e801 analyzer. Calcium, magnesium and phosphorus levels were analyzed by spectrophotometric method from Roche on a Cobas c702 analyzer. A positive result for SARS-Cov-2 virus was proved by molecular PCR method.
Results: A comparison of vitamin D levels in the group of survivors compared to the group of deaths due to COVID-19 disease was made and no statistical significance was observed, survivors vs deaths (44.0 ± 29.7 vs 36.1 ± 18.3), p = 0.376. What is noticeable is that both groups have lowered serum vitamin D levels. A blood count, calcium, magnesium and serum phosphorus levels were performed on all patients involved. We observe the greatest statistical significance in the ratio of neutrophils and lymphocytes p = 0.002, and that the age of the person affects the outcome of the disease p = 0.032 as well as the total number of leukocytes p = 0.028 and calcium levels p = 0.028. Measured vitamin D levels in correlation with the analyzed laboratory parameters did not show interdependence, there is no connection between the level of vitamin D and the number of leukocytes, neutrophilic granulocytes, lymphocytes, platelets, neutrophil-lymphocyte ratio, platelet-cell lymphocyte and lymphocyte lymphocytes. Multivariable logistic regression analysis showed that only leukocyte count was a statistically significant predictor of COVID-19 disease survival (OR 1,570, 95% CI 1,016 - 2,427; p = 0.041) when placed in the model along with basic characteristics such as age and sex and others basic laboratory parameters (OR 1,570, 95% CI 1,016 - 2,427; p = 0.041).
Conclusion: The outcome of COVID-19 disease in the elderly population is worse in the older age and the higher is the risk with a high total leukocyte count. Vitamin D levels are low in the study group but do not affect disease outcome and have no prognostic significance. The neutrophil-lymphocyte ratio is a predictor of the course of COVID-19 disease and should be considered in the treatment of therapy
Quality of life after total laryngectomy
No full textCilj: Ispitati kvalitetu života (QOL) u bolesnika s karcinomom larinksa nakon totalne laringektomije (TL) sa jednostranom ili obostranom disekcijom vrata i utvrditi razliku ovisno o modalitetu liječenja (TL sa jednostranom ili obostranom disekcijom vrata ± adjuvantna radioterapija ili kemoradioterapija).
Ispitanici i metode: Provedeno je presječno istrživanje u koje je uključeno 30 bolesnika nakon TL sa jednostranom ili obostranom disekcijom vrata liječenih u KBC Split u razdoblju od 1.1.2019. do 31.12.2021. Bolesnici su anketirani koristeći standardizirane upitnike o demografskim podacima, kvaliteti života i statusu gutanja (The University of Washington Quality of Life Questionnaire (UW-QOL) i M.D. Anderson Dysphagia Inventory (MDADI)).
Rezultati: U istraživanje je uključeno 30 bolesnika medijana životne dobi 67 (min-maks: 51-75) godina, od čega je 90% muškaraca. Više od 80% bolesnika je bilo srednje ili niže stručne spreme, a 60% bolesnika bilo je u (izvan)bračnoj zajednici. Ovisno o modalitetu liječenja ispitanici su podijeljeni u dvije skupine: u prvoj skupini (N=9) su bili bolesnici kod kojih je učinjena samo TL sa jednostranom ili obostranom disekcijom vrata, dok su u drugoj skupini (N=21) bili bolesnici kod kojih je nakon TL sa jednostranom ili obostranom disekcijom vrata provedeno adjuvantno onkološko liječenje (radioterapija ili kemoradioterapija). U obje skupine bolesnici su naveli visoku kvalitetu života (UW-QOL), medijan 925 vs 950, te zadovoljavajuću mogućnost gutanja (MDADI), medijan 92 vs 84.5. Nije dokazana statistički značajna razlika u ispitivanim varijablama (svi p>0,05). U post-hoc analizi pokazano je da su gutanje (p=0,023) i žvakanje (p=0,048) bili manje narušeni u skupini 1. Kao najvažniju subjektivnu stavku nakon liječenja, bolesnici su obje skupine naveli govor (svi p<0,05).
Zaključak: Bolesnici s karcinomom grkljana imaju subjektivno visoku kvalitetu života neovisno o modalitetu liječenja. Potrebno je multidisciplinarno zbrinjavanje svih potencijalnih terapijskih ograničavajućih i mutilirajućih ishoda liječenja, posebno govora.Objective: To examine the quality of life (QOL) in patients with laryngeal cancer after total laryngectomy (TL) with unilateral or bilateral neck dissection and to determine the difference depending on the treatment modality (TL with unilateral or bilateral neck dissection ± adjuvant radiotherapy or chemoradiotherapy).
Subjects and methods: A cross-sectional study including 30 patients after TL with unilateral or bilateral neck dissection treated at University hospital of Split in the period from 1st of January 2019. to 31st of December 2021. Patients were interviewed using standardized questionnaires on demographic data, quality of life and swallowing status (The University of Washington Quality of Life Questionnaire - UW-QOL and M.D. Anderson Dysphagia Inventory - MDADI).
Results: The study included 30 patients with a median age of 67 (min-max: 51-75) years, of which 90% were men. More than 80% of patients had lower education and 60% of patients were in an (extra)marital union. Depending on the treatment modality, the subjects were divided into two groups: in the first group (N = 9) there were patients in whom only TL with unilateral or bilateral neck dissection was performed, while in the second group (N = 21) there were patients in whom adjuvant oncological treatment (radiotherapy or chemoradiotherapy) was performed after TL with unilateral or bilateral neck dissection. In both groups, patients reported a high quality of life (UW-QOL), median 925 vs 950, and satisfactory swallowing ability (MDADI), median 92 vs 84.5. There was no statistically significant difference in the examined variables (all p> 0.05). Post-hoc analysis showed that swallowing (p = 0.023) and chewing (p = 0.048) were less impaired in group 1. As the most important subjective item after treatment, patients in both groups reported speech (all p <0.05).
Conclusion: Patients with laryngeal cancer have a subjectively high quality of life regardless of treatment modality. Multidisciplinary care is needed for all potential therapeutic limiting and mutilating treatment outcomes, especially speech
Correlation between bone density of the lumbar spine and fatty infiltration of psoas muscle in abdominal CT
No full textOsteoporoza je bolest smanjene koštane gustoće i predstavlja veliki javnozdravstveni problem, koji najčešće zahvaća osobe starije životne dobi, više žene nego muškarce. Osim promjena na kostima, koje nastaju s dobi, prisutne su i promjene na mišićima, a manifestiraju se kao atrofija i masna infiltracija mišića. Zlatni standard u dijagnostici osteoporoze je denzitometrija, metoda koja koristi rendgenske zrake dviju energija, a dobiveni rezultati se uspoređuju s rezultatima mlade, zdrave populacije u standardnim devijacijama. U zadnjih nekoliko godine sveprisutna je ideja oportunističkog CT probira smanjene gustoće kostiju, koja je pokazala izvrsnu korelaciju s denzitometrijom. Uz to, CT se pokazao kao izvrsna metoda u dijagnostici masne infiltracije mišića, koja se prikazuje kao niže vrijednosti u Hounsfieldovim jedinicama (H.J.), a može prikazati promjene koje nastaju infiltracijom masti od samo 3%. Cilj ovog istraživanja je bio odrediti možebitnu povezanost koštane gustoće slabinske kralježnice i masne infiltracije m. psoasa majora na CT abdomena u osoba mlađe i srednje životne dobi u kojih ne očekujemo izražene degenerativne promjene. Također, istražili smo utječe li primjena jodnog kontrastnog sredstva na mjerenja denziteta kosti i mišića na postkontrastnim fazama CT snimanja. Retrospektivno su analizirani slikovni materijali 113 ispitanika u dobi od 18 do 49 godina, koji su podvrgnuti višefaznom protokolu CT abdomena i zdjelice od srpnja do prosinca 2021. godine u KBC Split. Na aksijalnim presjecima su kružnim ROI-em mjerene H.J. trabekularnog dijela trupa L4 kralješka, a konture oba m. psoasa su iscrtavane ručno i u nativnoj, arterijskoj i venskoj fazi te također izražene u H.J. Rezultati su pokazali značajnu povezanost smanjene gustoće kostiju i masne infiltracije m. psoas majora s dobi ispitanika, a utvrđena je međusobna pozitivna korelacija smanjene koštane gustoće i masne infiltracije mišića. Nisu pronađene značajne razlike između spola ispitanika, izuzev nativno viših vrijednosti denziteta trupa L4 kralješka u ženskih ispitanica. Primjena jodnog kontrastnog sredstva značajno je utjecala na mjerene vrijednosti oba parametra. Razlika između nativnih i postkontrastnih mjerenja koštane gustoće L4 kralješka je u prosjeku iznosila 20 H.J., a denziteta m. psoasa majora oko 6-8 H.J., s tim da su postkontrastne razlike u denzitetima m. psoasa bile neznačajno više kod žena nego kod muškaraca. Dobivenim rezultatima smo potvrdili početnu hipotezu i smatramo da oportunistički dobiveni podatci s CT snimanja za druge indikacije uistinu mogu dati vrijedne podatke, koji se mogu iskoristiti u svrhu dijagnosticiranja smanjene gustoće kostiju i masne infiltracije mišića.Osteoporosis is a disease of reduced bone density, and it represents a major public health problem that most commonly affects the elderly, more often women than men. In addition to the age-related bone changes, age-related changes in the muscles are also recognized, and they manifest as atrophy and fatty infiltration of the muscles. The gold standard for the osteoporosis diagnosis is a densitometry, method that uses X-rays of two energies, and compares the results with those of a young, healthy population in standard deviations. In recent years, the idea of opportunistic CT screening of reduced bone density has been broadly introduced, showing an excellent correlation with densitometry. In addition, CT has proven to be an excellent method for the diagnosis of muscle infiltration, which is presented as lower values of Hounsfield units (H.U.), confirming that CT can show changes resulting from fat infiltration of only 3%. The aim of this study was to determine the possible association between bone density of the lumbar spine and fatty infiltration of the psoas major muscle on the abdominal CT in young and middle-aged people in whom the obvious degenerative changes are not to expect. We also investigated whether the use of iodine contrast agent affected bone and muscle density measurements in the postcontrast phases of CT imaging. The imaging materials of 113 subjects aged 18 to 49, who underwent a multiphase CT protocol of the abdomen and pelvis from July to December 2021 at the Clinical Hospital Center Split, were retrospectively analyzed. On axial CT slices, H.J. was measured by drawing a circular ROI in the trabecular part of L4 vertebra, and the contours of both psoas muscles were drawn manually and were expressed in anaverage H.U. The results showed a significant age correlation of a decreased bone density and fatty infiltration of psoas muscle with age, and a positive correlation between reduced bone density and fatty infiltration of a muscle. No significant differences were found between the sexes of the subjects, except for higher values of L4 vertebral body density in female subjects on native scans. The application of iodine contrast agent significantly affected the measured values of both parameters. The difference between native and postcontrast measurements of L4 vertebral bone density averaged 20 H.U., and the density of m. psoas major was 6-8 H.U., with postcontrast differences in density of m. psoas being slightly higher in women than in men. The results confirmed the initial hypothesis and we believe that opportunistic CT imaging for other indications can indeed provide valuable data, which can be used to diagnose reduced bone density and fatty muscle infiltration
Mehanical thrombectomy in stroke treatment
No full textAkutni moždani udar jedan je od vodećih uzroka smrti u svijetu, ali i među vodećima kada su u pitanju popratni poremećaji i poteškoće kao što je trajni invaliditet. Moždani udari dijele se na ishemijske i hemoragijske, a ishemijsko područje mozga prije pojave ireverzibilnog infarkta koje se naziva ishemijskom polusjenom i predstavlja rizično područje može se spasiti pravilnom reperfuzijom unutar ograničenog vremena.
Bez obzira na sve više saznanja i konstantnom proučavanju moždanih udara i njegovu liječenju, rtPA bila je donedavno jedina odobrena terapijska opcija za liječenje akutnog ishemijskog moždanog udara. Danas je metoda izbora mehanička trombektomija jer pokazuje značajno bolji ishod lječenja u komparaciji sa i.v. trombolizom i ima znatno širi vremenski okvir. Do sada je vremenski okvir za MT bio unutar 6 sati, danas se zna da pacijenti sa malim infarktom i povoljnim omjerom penumbre i infarkta imaju koristi od MT i nakon 6 sati tako da se taj vremenski okvir pomiče i na 24 sata.Uzimajući u obzir cost-benefit i rezultate nedavnih studija koje nisu našle značajnu razliku u korištenju stent-retrivera i aspiracijskih katetera, aspiracija bi trebala biti početne metoda MT koja se u slučaju neuspjeha nastavlja kao kombiranatehnika.Acute stroke is one of the leading causes of death in the world, but also among the leading ones when it comes to concomitant disorders and difficulties such as permanent disability. Strokes are divided into ischemic and hemorrhagic, and the ischemic area of the brain before an irreversible infarction called an ischemic penumbra and is a risk area can be saved by proper reperfusion within a limited time.
Despite increasing knowledge and the constant study of stroke and its treatment, rtPA was until recently the only approved therapeutic option for the treatment of acute ischemic stroke. Today, the method of choice is mechanical thrombectomy because it shows a significantly better treatment outcome compared to i.v. thrombolysis and has a significantly broader time frame. Until now, the time frame for MT was within 6 hours, today it is known that patients with a small infarction and a favorable ratio of penumbra and infarction benefit from MT even after 6 hours, so that time frame is moved to 24 hours. Given the cost-benefit and results of recent studies that have found no significant difference in the use of stent-retrievers and aspiration catheters, aspiration should be the initial MT method that continues in case of failure as a combined technique