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Aspirin Versus LMWH for Thromboprophylaxis Following Hip or Knee Arthroplasty—Clinical Implications and Budget Impact
No full textABSTRACT Venous thromboembolism (VTE) remains a significant concern for patients undergoing hip or knee arthroplasty, with a need to balance effective thromboprophylaxis and bleeding risk. We aimed to compare the efficacy, safety, and budget impact of aspirin versus low‐molecular‐weight heparin (LMWH) as sole thromboprophylactic agents initiated immediately postoperatively in this population. First, we conducted a systematic review of randomized controlled trials (RCTs) from Ovid MEDLINE, Embase, and Cochrane CENTRAL databases, assessing clinical outcomes and healthcare costs. Subsequently, a simplified budget impact analysis was performed using data from the largest identified and most recent RCT (CRISTAL trial) and its secondary analyses. Primary outcomes included symptomatic VTE, bleeding events, and reoperation rates. Through a systematic search, seven RCTs were considered to be eligible, with the CRISTAL trial providing the most compelling evidence. Aspirin was non‐inferior to LMWH for all‐cause mortality but was associated with a significantly higher symptomatic VTE rate (3,27% vs. 1,76%) and deep vein thrombosis (DVT), predominantly distal DVT. The budget impact analysis revealed that despite aspirin's lower per tablet cost, thromboprophylaxis with LMWH led to annual savings of 110,431,241 for U.S. healthcare stakeholders, and 56,450 for single hospitals performing 1000 arthroplasty procedures annually. To conclude, enoxaparin appears to offer superior clinical efficacy and cost‐effectiveness compared to aspirin for thromboprophylaxis following hip and knee arthroplasty. These findings support the preferential use of LMWH in this setting, while highlighting the need for further investigation into the clinical significance of aspirin's higher distal DVT and pulmonary embolism risk
Rights of the Parties during the Inspection Supervision Procedure
No full textCilj je ovoga rada utvrditi koja postupovna prava stoje na raspolaganju stranci u postupku inspekcijskog nadzora u Hrvatskoj, s ciljem zaštite njezinih prava u ovom postupku. U radu se najprije analizira pravna regulacija inspekcijskog nadzora u Hrvatskoj, a zatim se utvrđuje pravna priroda ovog oblika nadzora. Konačno, razmatraju se prava nadzirane osobe pri pokretanju postupka inspekcijskog nadzora, utvrđivanju činjenica u ovom postupku, pravo izjasniti se o činjenicama, okolnostima i pravnim pitanjima, pravo izvršiti uvid u spis te njezino pravo ukazati na netočnosti pri sastavljanju zapisnika kojim se inspekcijski nadzor okončava. U radu se, radi izvođenja zaključaka, koriste i izvori talijanskog, slovenskog i srpskog prava. Zaključuje se kako se prava stranaka u postupku inspekcijskog nadzora, prvenstveno, štite točno i istinito utvrđenim činjenicama i okolnostima vezanima uz obavljanje aktivnosti stranke te pravnim lijekovima u upravnom postupku, kojim se ovim osobama, po okončanju postupka inspekcijskog nadzora, izriču upravne ili prekršajne mjere.The aim of this paper is to determine which procedural rights are available to a party in the inspection supervision procedure in Croatia, with the goal of protecting their rights in this process. The paper begins by examining the legal regulation of inspection supervision in Croatia. It then examines the legal nature of this form of supervision. Finally, this paper considers the rights of the supervised party at various stages of the inspection procedure, including the initiation of the inspection procedure, the right to establish facts, to express opinions on facts, circumstances and legal issues, the right to access the case file and the right to point out inaccuracies in the preparation of the inspection report concluding the inspection supervision procedure. Drawing on sources from Italian, Slovenian, and Serbian law, the paper concludes that party rights in the inspection supervision procedure are primarily protected by ensuring the accurate and truthful determination of facts and circumstances related to their activities, as well as through legal remedies available in administrative proceedings where administrative or misdemeanour measures are imposed on these persons after the completion of the inspection supervision procedure
APPLICATION OF LEGAL NORM: JUDICIAL ARGUMENTATION
No full textOvaj rad bavi se primjenom pravne norme, s posebnim naglaskom na argumentaciju konkretnih pravnih odluka. U uvodu se objašnjava proces primjene pravne norme kroz četiri faze: utvrđivanje, tumačenje, popunjavanje pravnih praznina i izvršenje norme. Poseban naglasak stavljen je na razliku između lakih i teških slučajeva, pri čemu su teški slučajevi posebno važni zbog potrebe za argumentacijom i opravdanjem odluka. U prvom dijelu rada analiziraju se teorije argumentacije od antike do 20. stoljeća, uključujući pristupe sofista, Aristotela, rimskih pravnika te novovjekovnih filozofa. Drugi dio obrađuje suvremene teorije argumentacije, s naglaskom na doprinos Viehwega, Perelmana i predstavnika standardne teorije poput Alexyja i Aarnija. Kako bi se bolje razumjela uloga argumentacije u pravnom procesu, važno je razlikovati tumačenje i argumentaciju. Tumačenje podrazumijeva otkrivanje i utvrđivanje značenja pravnih normi, dok argumentacija predstavlja proces kojim se te norme primjenjuju i opravdavaju u konkretnim slučajevima. Iako je teško formirati iscrpnu listu pravnih argumenata, najpoznatija i najpraktičnija klasifikacija je Tarellova, koja će se u radu koristiti za prikazivanje i analizu argumentacije u praksi. Cilj rada je prikazati ulogu pravne argumentacije u procesu primjene pravne norme, s naglaskom na njezinu važnost u donošenju i obrazlaganju pravnih odluka.This paper deals with the application of legal norms, with a special emphasis on the argumentation of concrete legal decisions. The introduction explains the process of applying a legal norm through four stages: determination, interpretation, filling legal gaps, and enforcement of the norm. Special attention is given to the distinction between easy and hard cases, with hard cases being particularly important due to the need for argumentation and justification of decisions. The first part of the paper analyzes theories of argumentation from antiquity to the 20th century, including approaches of the sophists, Aristotle, Roman jurists, and modern philosophers. The second part addresses contemporary theories of argumentation, emphasizing the contributions of Viehweg, Perelman, and representatives of the standard theory such as Alexy and Aarni. To better understand the role of argumentation in the legal process, it is important to distinguish between interpretation and argumentation. Interpretation involves uncovering and determining the meaning of legal norms, while argumentation represents the process by which these norms are applied and justified in concrete cases. Although it is difficult to form an exhaustive list of legal arguments, the most well-known and practical classification is Tarrel’s, which will be used in this paper to present and analyze argumentation in practice. The aim of the paper is to demonstrate the role of legal argumentation in the process of applying legal norms, with an emphasis on its importance in making and explaining legal decisions
Quality system management in an emergency medicine institution
No full textUpravljanje kvalitetom unutar poslovnog okruženja predstavlja dinamičan proces koji zahtijeva stalno unapređenje i prilagodbu. Jedan od pristupa poboljšanju je uvođenje potpuno novih koncepata u sustave upravljanja kvalitetom.
Kako bi upravljanje kvalitetom bilo učinkovito, važno je integrirati normu ISO 9001, odnosno primijeniti temeljna načela koja propisuje ISO standard. Time se osigurava kontinuirani napredak i usavršavanje procesa. Kvalitetna primjena ISO 9001 može se postići putem cjelovitog sustava upravljanja kvalitetom, uz korištenje PDCA ciklusa, procesnog pristupa i metode šest sigma. Ovim metodama podiže se razina kvalitete svih poslovnih aktivnosti, što rezultira većim zadovoljstvom i unutarnjih i vanjskih sudionika. Takav pristup uspostavi kvalitete može se uspješno primijeniti i u Zavodu za hitnu medicinu.
Hitna medicinska služba ključna je sastavnica zdravstvenog sustava koja osigurava brzu i učinkovitu pomoć pacijentima u hitnim stanjima. Cilj ovog istraživanja je analizirati zadovoljstvo zaposlenika te identificirati ključne izazove i mogućnosti unaprjeđenja sustava u skladu s ISO 9001 standardom. U istraživanju se koristi anketa kao primarna metoda prikupljanja podataka.Quality management in a business environment is a dynamic process that requires continuous improvement and adaptation. One approach to enhancement is the introduction of entirely new concepts into quality management systems.
For quality management to be effective, it is essential to integrate the ISO 9001 standard and apply its core principles. This ensures ongoing progress and refinement of processes. The successful implementation of ISO 9001 can be achieved through a comprehensive quality management system, utilizing the PDCA cycle, process-based management, and the Six Sigma methodology. These approaches enhance the quality of all business operations, leading to greater satisfaction among both internal and external stakeholders.
Such a quality management framework can also be effectively applied to the Institute for Emergency Medicine.
Emergency medical services are a key component of the healthcare system, providing rapid and effective assistance to patients in critical conditions. The aim of this study is to analyze employee satisfaction and identify key challenges and opportunities for system improvement in line with the ISO 9001 standard. A survey is used as the primary data collection method
Contribution to the Research on Marine Environment Pollution from Nautical Tourism Vessels
No full textNautical tourism has experienced significant growth, particularly in the last thirty years. Alongside
its many socioeconomic impacts, there are also negative effects on the marine environment and,
consequently, on humans. The increase in the number of nautical tourism vessels can lead to high
concentrations of bacteria and other organisms that harm the ecosystem. The implementation of
international conventions aims to protect human life and the marine environment, but this is still not
enough. The adoption of specific conventions exclusively focused on nautical tourism could reduce
the ecological risks resulting from various human activities at sea and along the coast. The authors
provide an overview and analysis of legal regulations while explaining the importance of improving
the regulation of issues related to pollution in the marine environment from nautical tourism vessels.
An analysis of ecological risks of pollution in the marine environment from nautical tourism vessels
has been conducted and preventive measures are proposed. The contribution of this study lies in
the analytical review of legal literature and ecological risks, as well as proposing measures that can
contribute to the long-term reduction of pollution in the marine environment from nautical tourism
vessels
Genetic Testing for Monogenic Forms of Male Infertility Contributes to the Clinical Diagnosis of Men with Severe Idiopathic Male Infertility
No full textPurpose: In recent years, many genes have been associated with male infertility; however, testing of monogenic forms has not yet been clinically implemented in the diagnosis of severe forms of idiopathic male infertility, as the diagnostic utility has not been established yet. The aim of this study was therefore to answer if the implementation of genetic testing for monogenic forms of male infertility could contribute to the clinical diagnosis of men with severe forms of idiopathic male infertility. Materials and Methods: Based on the ClinGene curation protocol, we defined a panel of genes with sufficient evidence for the involvement with severe male infertility. We tested the 21-gene panel in a representative multicentric cohort of men with significantly impaired spermatogenesis. We performed whole exome sequencing on 191 infertile men with severe forms of idiopathic male infertility; non-obstructive azoospermia, and severe oligozoospermia (T, p.Arg926*; c.2817delG, p.Leu940fs), MSH4 (c.1392delG, p.Ile465fs; c.2261C>T, p.Ser754Leu), TEX15 (c.6848_6849delGA, p.Arg2283fs; c.6271dupA, p.Arg2091fs), and TEX14 (c.1021C>T, p.Arg341*) genes were found. Conclusions: In the present multicentric cohort study, a monogenic cause in 2.1% of infertile men was identified. These findings confirm the utility of monogenic testing and suggest the clinical use of monogenic testing for men with severe forms of idiopathic male infertility
Croatian nursing students’ motives for enrolling in the Master of Nursing program despite limited career opportunities: a qualitative study
No full textBackgroundIn 2022, only 1.7% of nurses in Croatian healthcare were employed at a job defined as a Master of Nursing (MN) graduate. In the current labour market, most MN graduates in Croatia cannot hope for salary increases or better employment opportunities after graduation. Thus, it is unclear what motivates students to enrol in MN studies, and how they perceive their career possibilities after graduation.AimTo explore the motives of Croatian nursing students for enrolling in the MN program despite uncertainty regarding their future salary and career status.MethodsA qualitative study was conducted. Thematic analysis was conducted on the narratives gathered from semi-structured interviews with full-time and part-time students in Croatia.ResultsWe included 30 students of MN programs attending seven MN institutions. The main themes identified for both full-time and part-time students' motivation to enrol in MN studies were a desire for personal and professional growth and various practical considerations. Optimism about future career prospects was a strong motivation for part-time students. Involvement in scientific work and education was the most common perceived benefit for future professional development with an MN degree for both groups of participants.ConclusionOur findings offer valuable insights into the motivating factors behind MN studies, especially in situations where the value of the MN qualification is under scrutiny, and immediate career or financial benefits may not be apparent upon graduation. Understanding these motivations allows educational and professional organizations to enhance their support for MN graduates looking to advance their careers. By aligning career pathways with their aspirations and motives, nurses can achieve personal fulfilment, even if financial compensation is not their primary motivatio
Management of liver sinusoidal obstruction syndrome/veno-occlusive disease in adults: a 2025 perspective from an international expert group
No full textinusoidal obstruction syndrome (SOS) formerly known as Veno-occlusive disease (VOD) is a potentially fatal complication that occurs mainly after haematopoietic cell transplantation, especially allogeneic transplantation. The liver is the principal organ affected, though other organs, such as the lungs, may also be involved to a lesser extent. The condition is characterised by obstruction of the hepatic venules, leading to sinusoidal congestion, hepatic ischaemia and, in severe cases, fulminant liver failure. Recent refined diagnostic criteria, published by the European Society for Blood and Marrow Transplantation in 2023, provide a more accurate method of detecting SOS/VOD, allowing earlier intervention and better stratification of patients according to the severity of their disease. This article focuses on liver SOS/VOD and discussing key risk factors, new diagnostic methods and therapeutic strategies, with an emphasis on the early use of defibrotide, which remains the reference treatment for severe SOS/VO
SEPARACIJA I SVOJSTVA EGZOSOMA IZ CEREBROSPINALNE TEKUĆINE BOLESNIKA S TRAUMATSKOM OZLJEDOM MOZGA
No full textObjectives: Severe traumatic brain injury (sTBI) is a complex, life-threatening
condition requiring emergent treatment with no known biomarkers to guide clinical
interventions. A promising source of such biomarkers are intracranial exosomes.
However, isolation of exosomes is still challenging with size exclusion chromatography
(SEC) emerging as a favourable tool to isolate total and intact exosomes. This study
aims to compare the efficiency of different SEC solutions for exosome isolation from
cerebrospinal fluid (CSF) of sTBI patients.
Patients and methods: Nine CSF samples from three patients requiring external CSF
drainage during the first three days post-sTBI were collected, pooled, and screened by
western blot for exosomal makers CD81 and CD9, lipoprotein markers apolipoprotein
AI (ApoAI) and E (ApoE), and albumin. The pooled sample was separated by four
gravity flow-based SECs with either a commercial prepacked column or an in-house
column packed with Sepharose CL-6B, Sephacryl S-400 or Superose 6 PG. A total of
46 fractions were collected per SEC and analysed by slot blot followed by Ponceau
staining. Immunodetection was performed on selected SEC fractions for albumin,
CD81, CD9, flotillin-1, ApoAI, and ApoE. Tunable resistive pulse sensing (TRPS) was
utilised for exosome size, concentration and surface charge measurement, while
transmission electron microscopy (TEM) was used for exosome visualisation.
Results: Post-sTBI CSFs contain exosomes, along with lipoproteins and albumin, as
shown by western blot, confirming the complexity of clinical samples. All four tested
SECs provided separation of exosomes but differed in efficiency. Sepharose CL-6B
SEC yielded the highest quantity of exosomes in TRPS measurement and resulted in
clear separation from lipoproteins and free proteins, as shown by exosome
visualisation by TEM and immunodetection of exosomal (CD9, CD81 and flotillin-1),
lipoprotein (ApoA1 and ApoE) and free protein (albumin) markers.
Conclusion: Intracranial CSF after sTBI has a complex composition encompassing
exosomes, lipoproteins and free proteins, which can be separated by SEC. However,
SEC designs vary and impact the exosome isolation efficiency. Sepharose CL-6B
stands out as an effective SEC resin to isolate exosomes from clinical samples.Cilj istraživanja: Teška traumatska ozljeda mozga (tTOM) je kompleksno životno
ugrožavajuće stanje koje zahtjeva hitno liječenje, ali nema poznatih biomarkera koji bi
pomogli u odlučivanju o kliničkim intervencijama. Intrakranijalni egzosomi predstavljaju
obećavajući izvor takvih biomarkera. Međutim, izolacija egzosoma je i dalje izazovna,
a kromatografija isključenjem po veličini (eng. Size Exclusion Chromatography, SEC)
pojavljuje se kao prikladan alat za izolaciju ukupnih i intaktnih egzosoma. Cilj ovog
istraživanja je usporediti učinkovitost različitih rješenja SEC-a za izolaciju egzosoma iz
CSF-a pacijenata s TBI.
Ispitanici i metode: Devet uzoraka CST-a od triju pacijenata kojima je uspostavljena
vanjska drenaža CST-a tijekom prva tri dana nakon tTOM-a prikupljeno je, objedinjeno
i ispitano western blot metodom na egzosomalne markere CD81 i CD9, lipoproteinske
markere apolipoprotein AI (ApoAI) i E (ApoE) te albumin. Skupni uzorak CST-a
odvojen je pomoću četiri metode SEC-a temeljene na gravitacijskom protoku, pomoću
komercijalne kolone za izolaciju egzosoma ili interno pakiranim kolonama napunjenim
punilima Sepharose CL-6B, Sephacryl S-400 i Superose 6 PG. Prilikom svake
separacije prikupljeno je ukupno 46 frakcija, nakon čega je uslijedila slot blot analiza i
bojanje Ponceau S. Imunodetekcija na odabranim frakcijama SEC-a provedena je na
albumin, CD81, CD9, flotillin-1, ApoAI i ApoE. Za mjerenje veličine, koncentracije i
površinskog naboja egzosoma korištena je metoda opažanja pomoću podesivog
otpornog pulsa (eng. Tunable Resistive Pulse Sensing, TRPS), dok je transmisijska
elektronska mikroskopija (TEM) korištena za vizualizaciju egzosoma.
Rezultati: CST nakon tTOM sadrži egzosome, lipoproteine i albumin, kao što je
prikazano western blotom, što govori u prilog kompleksnosti kliničkih uzoraka. Sve
četiri SEC metode omogućile su odvajanje egzosoma, ali su pritom pokazale različitu
učinkovitost. Prema mjerenjima pomoću TRPS, razdvajanje punilom Sepharose-CL
6B dovelo je do najvećeg prinosa egzosoma i rezultiralo jasnim odvajanjem od
lipoproteina i slobodnih proteina, kao što je prikazano vizualizacijom egzosoma
pomoću TEM-a i imunodetekcijom egzosoma (CD9, CD81 i Flotillin-1), lipoproteina
(ApoA1 i ApoE) i markera slobodnih proteina (albumin).
Zaključak: Intrakranijalni CST nakon tTOM složenog je sastava te sadrži egzosome,
lipoproteine i slobodne proteine, koji se mogu razdvojiti SEC-om. Međutim, dizajn SEC-a može značajno varirati i utjecati na učinkovitost izolacije egzosoma. Sepharose
CL-6B ističe se kao učinkovito punilo za kromatografsku izolaciju egzosoma iz kliničkih
uzoraka
