1,720,999 research outputs found
Importance of indicators for glaucoma in diabetic retinopathy screening programme
No full textOzadje in namen dela: Zgodnje odkrivanje glavkoma lahko izboljšamo z oportunističnim presejanjem v presejalnem programu za diabetično retinopatijo (PPDR). S študijo smo želeli ugotoviti, kakšna je napovedna vrednost kazalnikov s fotografij očesnega ozadja kot testa za glavkom v populaciji bolnikov, ki se spremljajo v PPDR, kakšna je relativna pomembnost kazalnikov pri ugotavljanju glavkoma v PPDR in kakšna njihova diagnostična vrednost.
Metodologija: Pregledali smo fotografije očesnega ozadja bolnikov, ki so bili obravnavani v PPDR na Očesni kliniki Univerzitetnega kliničnega centra Ljubljana od novembra 2019 do januarja 2020 in od maja 2020 do avgusta 2020. Bolnike z vsaj enim kazalnikom za glavkom sumljivega videza papile vidnega živca in nekaj naključno izbranih bolnikov brez kazalnikov smo povabili na očesni pregled. Za bolnike z glavkomom in sumom na glavkom smo smatrali, da so bili na pregled napoteni upravičeno. S pomočjo logistične regresije in posplošene ocenjevalne enačbe z logistično regresijo smo določili, kolikšna je napovedna vrednost kazalnikov za ugotavljanje, kdo potrebuje pregled zaradi suma na glavkom na podlagi kazalnikov s fotografij očesnega ozadja. Z ROC analizo smo določili diagnostično vrednost kazalnikov in napovednega modela.
Rezultati: Pregledali smo fotografije 2230 bolnikov iz PPDR. 209 bolnikov (10,1 %) je imelo na fotografijah vsaj 1 kazalnik. Skupno se je na vabilo na pregled odzvalo 149 bolnikov (129 z vsaj 1 kazalnikom, 20 brez kazalnikov), izmed katerih pri 79 (53,0 %) bolnikih nismo ugotavljali glavkoma, 54 bolnikom (36,2 %) smo postavili diagnozo sum na glavkom in 16 bolnikom (10,7 %) diagnozo glavkom. Sedem bolnikov z glavkomom za diagnozo predhodno ni vedelo. Vsi bolniki s kazalnikom zažetje nevroretinskega obroča so imeli glavkom. Kazalnik C/D razmerje je bil najpomembnejši za ugotavljanje glavkoma/suma na glavkom (razmerje obetov 7,59 (95 % interval zaupanja 3,98–14,47p < 0,001)) in je ostal statistično značilno pomemben v multivariatnem modelu. Vpliv na ugotavljanje glavkoma/suma na glavkom je imela tudi pozitivna družinska anamneza za glavkom, vendar je ostala statistično značilno pomembna le v multivariatnem modelu.
Ploščina pod ROC krivuljo za končni LOGIT model (oz. za verjetnosti za izid, ki jih model napove), v katerem sta bila vsebovana družinska anamneza za glavkom in C/D razmerje, je bila 0,967 (95 % interval zaupanja 0,944-0,990p<0,001).
Zaključek: PPDR predstavlja priložnost za odkrivanje novih primerov bolezni, saj je glavkom v približno polovici primerov nediagnosticiran. Študija je pokazala, da sta za napotovanje iz PPDR na očesni pregled zaradi suma na glavkom/glavkoma najpomembnejša kazalnik C/D razmerje in zažetje NRO. Glede na pomembnost pozitivne družinske anamneze za glavkom bi bilo smiselno bolnike iz PPDR povprašati o glavkomu v družini. Potrebna bi bila validacija modela na novem vzorcu PPDR.Background and objectives: Retinal images from diabetic retinopathy screening programmes (DRSP) provide an opportunity to improve early glaucoma detection. The aim of our study was to find out the predictive value of the retinal image indicators as a test for glaucoma in a population of patients from a DRSP, the relative importance of retinal image indicators for glaucoma detection in a DRSP and their diagnostic value.
Methods: We reviewed retinal images of patients, who attended the DRSP at the University Medical Centre Ljubljana from November 2019 to January 2020 and from May to August 2020. We invited patients with at least one indicator and some randomly selected patients without indicators for an ophthalmic examination. Patients with glaucoma and suspect glaucoma were considered accurately referred. Logistic regression (LOGIT) and generalised estimating equation with logistic regression (GEE) were used to find out the referral accuracy of retinal image indicators. ROC analysis was used to determine the diagnostic value of the indicators and the predictive model.
Results: Of the 2230 patients reviewed, 209 patients (10.1 %) had at least one indicator on their retinal images. 129 patients with at least one indicator and 20 patients without indicators (n = 149) attended the eye exam. Seventy-nine patients (53.0 %) were diagnosed glaucoma negative, 54 (36.2 %) suspect glaucoma, and 16 (10.7 %) glaucoma positive. Seven glaucoma patients were newly detected. All patients with a neuroretinal rim notch had glaucoma. The cup-to-disc ratio was the most important indicator for accurate referral (odds ratio 7.59 (95 % confidence interval 3.98–14.47p < 0.001) and stayed statistically significant in a multivariable analysis. Positive family history of glaucoma also affected referral accuracy but was showed to be statistically significant only in the LOGIT multivariable model. Other indicators and confounders lost their statistical significance in multivariable analyses.
The area under the ROC curve for a final LOGIT model (i.e. for its predicted outcome probabilities), consisting of the family history of glaucoma and the cup-to-disc ratio, was 0,967 (95 % confidence interval 0,944-0,990p<0,001).
Conclusions: With approximately half of the patients undiagnosed, DRSP has the potential for glaucoma detection. Our study showed that the cup-to-disc ratio and the neuroretinal rim notch are the most important indicators for accurate glaucoma referral from retinal images in DRSP. It would be reasonal to ask patients from the DRSP about their glaucoma family history since this it was showed to be important in predicting suspect glaucoma referrals. Validation on a new DRSP sample is needed
Health manpower planning in Slovenia: A policy analysis of the changes in roles of stakeholders and methodologies
No full textA heightened awareness about medical manpower issues can be observed in countries that are in a state of political, economic, and social transition. Slovenia entered the transition process in 1989 and became an independent country in 1991. Transition and independence influenced its health care in several ways. It changed the health care system and its financing (by introducing a Bismarckian style of social insurance). It then redistributed power from the Ministry of Health to several stakeholders. A major change occurred in the labor market in health care when the flow of health professionals from the newly independent countries greatly decreased. The decrease was partly due to the consequences of the war in the Balkans and partly due to independent labor legislation in Slovenia. Transitional changes brought new stakeholders to the scene, with a resulting redistribution of responsibilities for health manpower policies and the use of various methodologies. This policy analysis offers a detailed description of the contextual framework, quantitative data on medical manpower development, and, most important, interviews with representatives of the key stakeholders and study of relevant policy documents. We conclude that all stakeholders underpin the need for a structured approach toward health manpower planning in the form of a more coherent system of planning, decision making, and control. A compromise on mutual responsibilities between the less dominant Ministry of Health and the two new powerful stakeholders, the Health Insurance Institute of Slovenia and the Medical Chamber of Slovenia, seems necessar
Privatisation of health care in Slovenia in the period 1992-2008
No full textObjectives To discuss the background, nature and facilitating and hindering factors of the privatisation process in health care in Slovenia.Methods Descriptive analyses of legal and policy documents mapping the situation in Slovenia against an internationally established taxonomy and typology. Description of the scope and volume of the different types of privatisation.Results Determined by the political will, privatisation in health care in Slovenia has been a gradual process. In 2008, it applies to 30% of the primary care providers (GPs, paediatricians and school medicine doctors), almost 60% of providers in dentistry and about 20% of providers of outpatient specialist care. In the hospital setting, privatisation remained limited and there have not been significant private investments in health infrastructure. Privatisation of health insurance (including insurance to cover co-payments) has steeply risen to 15% of the total health expenditure (THE), while out-of-pocket payments reached 12% of the THE.Conclusions Slovenia's privatisation in health care is focused on primary health care and on health expenditures. Controversies over its extent kept privatisation contained and controlled. Today's share of private provision of health services remains at the conservative end of the European Union. Private expenditures for health services increased considerably, while privatisation of health infrastructure and management has so far been limited. Concerns about the future course of privatisation relate to the issues of equity, fairness and solidarity.Health care Privatisation Health care reforms
Monitoring of Quality in Health Care Using Indicators: Challenges and Possible Solutions
Full text linkA number of stakeholders identified the need to revise the national set of quality indicators. The objectives of monitoring quality indicators that were determined in 2010 for the most part were not accomplished. Key reasons include: insufficient communication between stakeholders after the indicator set was introduced, insufficient definition of human and financial resources necessary for indicators\u27 monitoring, lack of a thorough ICT structure that could support indicators\u27 monitoring and weak leadership for these activities. A new performance indicators\u27 set requires a clear identification of the objectives to be pursued and consequently of the theoretical framework for the indicators. Mostly it is necessary in addition to the identification of the challenges so far, to also recognize what are the possibilities to strengthen this area in the future
Monitoring of quality in health care using indicators
Full text linkA number of stakeholders identified the need to revise the national set of quality indicators. The objectives of monitoring quality indicators that were determined in 2010 for the most part were not accomplished. Key reasons include: insufficient communication between stakeholders after the indicator set was introduced, insufficient definition of human and financial resources necessary for indicators\u27 monitoring, lack of a thorough ICT structure that could support indicators\u27 monitoring and weak leadership for these activities. A new performance indicators\u27 set requires a clear identification of the objectives to be pursued and consequently of the theoretical framework for the indicators. Mostly it is necessary in addition to the identification of the challenges so far, to also recognize what are the possibilities to strengthen this area in the future
Bringing cancer back to the top of the EU health agenda
No full textSlovenia put forth cancer as the main topic for its Presidency to the Council of the European Union. This paperdescribes the process, which led to the adoption of the Council Conclusions on cancer in June 2008.Theprocess included the production of two policy dialogues, a book on cancer, a conference on cancer and theCouncil\u27s conclusions, which aim to inform EU health policy in the field of cancer. As a problem of growingpublic health importance, cancer needs to be addressed on the four levels, which cover its key elements –primary prevention, screening, integrated cancer care and research. These should become parts of aconsistent national strategy to address cancer in developing a national cancer plan based on a common EUstrategy for an integral approach to cancer management
Restructuring public health in Slovenia between 1985 and 2006
No full textOBJECTIVE: This paper explores the developments in the public health infrastructure in Slovenia in the context of the sociopolitical and legislative changes in health care over the last 20 years. It assesses the responsiveness of the public health institutes in Slovenia to the various plans on public health developed by health policy makers over time METHODS: After an in-depth and externally validated search for key documents, we analysed the legislation, policy documents, research reports, theses, and other health policy papers related to the public health infrastructure in Slovenia. Findings were validated through consulting 3 external experts on public health in Slovenia. RESULTS: In the period discussed only few new services were added and health promotion was developed as an institutional field. Passivity in the past caused a lack of decisions on some traditional services in a changed economic environment. Moving from a passive supporter of the former infrastructure to an active promoter of the reform sets health policy as the main architect of the new public health building. CONCLUSION: Slovenia's "house" of public health was amended and refurbished, but a thorough reconstruction has not taken place. In order to face the future challenges in public health, the infrastructure will require increased efficiency, professional workforce development and better responsivenes
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