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  • Author: Marko Divjak x
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Abstract

Introduction

The purpose of this study is to analyse and present the causes of the differences in crude utilization rate in cardiac implantation electronic devices, specifically pacemakers and automatic implantable cardioverter-defibrillators, across 5 European countries, with a specific emphasis on Slovenia.

Methods

Based on the results of the analysis of the uptake of cardiac implantation electronic devices across countries studied in MedtecHTA project, the targeted interviews were conducted to explain the factors that impact the differences and explain data in Slovenia.

Results

The reasons for the differences in crude utilization rate across 5 European countries were multiple: the first group of differences refers to the coding system and linkages between coding and financing of health care. The second group of reasons can be qualitatively ascribed to the economic situation, financial situation in health care, and its impact on decision-making. The last reason is the non-existence of the golden rule for optimal crude utilisation rate.

Conclusions

It is evident that the differences in the uptake of cardiac implantation electronic devices among the countries are of organisational nature: they refer to the system of coding, the importance attached to correct coding practices, the link between coding and financing of health care as well as the availability of private clinics and private insurance. According to the interviews, the economic development of the country also impacts those differences, whereas the differences in clinical practice and guidelines are claimed not to play a role in the explanation of the differences.

Abstract

Acute pancreatitis represents an acute nonbacterial inflammation of the pancreas caused by a premature and ectopic activation of pancreatic digestive enzymes. Two of the most important genes in pancreatic autodigestion, PRSS1 and SPINK1, were implicated in the earliest discoveries of the genetic background of pancreatitis. However, the distribution of their variations displays interethnic variability, which could significantly affect the magnitude of their proposed effects on this disease worldwide. The aim of the present study was to investigate the distribution of the most important functional variations of PRSS1 (86A>T and 365G>A) and SPINK1 (101A>G), and their influence on the clinical course of acute pancreatitis in Serbian patients. The study enrolled 81 subjects, the severity of disease course was determined using the Atlanta Classification system, and the genotyping was conducted using a PCR-RFLP method. PRSS1 86A>T and 365G>A SNPs were not observed in the study population, while SPINK1 101A>G was present with the frequency of 0.62% (95% CI: 0.00, 3.83%). Due to extremely low frequencies or absences of examined variations, the proposed effect of these SNPs on the severity of acute pancreatitis could not be confirmed. The results do not support routine genotyping of either PRSS1 or SPINK1 in Serbs.

Abstract

Acute necrotizing pancreatitis (ANP) is a severe form of acute pancreatitis that is associated with high morbidity and mortality. Thus, an adequate initial treatment of patients who present with acute pancreatitis (AP) based on correct interpretation of early detected laboratory and clinical abnormalities may have a significant positive impact on the disease course.

The aim of the study was to determine patient- and initial treatment-related risk factors for the development of acute necrotizing pancreatitis.

For the purpose of this study a case-control design was chosen, including adult patients treated for AP in the surgical Intensive Care Unit (sICU) of Clinical Center of Kragujevac, from January 2006 to January 2011. The cases (n=63) were patients who developed ANP, while the controls (n=63) were patients with AP without the presence of pancreatic necrosis. The controls were randomly selected from a study sample after matching with the cases by age and sex.

Significant association with the development of ANP was found for the presence of comorbidity (adjusted OR 6.614 95%CI 1.185-36.963), and the use of somatostatin (adjusted OR 7.460, 95%CI 1.162-47.833) and furosemide (adjusted OR 2710.57, 95%CI 1.996-56.035) started immediately upon admission to the sICU.

This study suggests that comorbidities, particularly the presence of serious cardio-vascular disease, can increase the risk for development of acute necrotizing pancreatitis. The probability for the development of ANP could be reduced by the avoidance of the initial use of loop diuretics and somatostatin.