Medicinski arhiv
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Controlled Clinical Trial
Alpha lipoic acid and glycaemic control in diabetic neuropathies at type 2 diabetes treatment.
Diabetes mellitus is a metabolic, chronic and incurable disease which reduces span and quality of life. Over 50% of diabetic patients have clinical manifestations of diabetic neuropathy. ⋯ Alfa lipoic acid is an effective drug in the treatment of diabetic distal sensory-motor neuropathy and its therapeutic effect is more effective in patients with good glycaemic control.
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PhD degree in nursing is a relatively recent phenomenon and there is not enough experience in making the initial studies for the start of such studies. While nursing in the countries of Western Europe, USA, Asia, Canada and New Zealand develop as in the professional as well as in academic direction, our region has failed to catch up with these changes. The past 20 years is characterized by turbulent changes in the development of medical science and in line with these changes developed the idea of PhD studies. ⋯ Doctors in the field of nursing contribute to the development of education, quality assurance, development of scientific research and the advancement of nursing as a profession. Shortage of highly trained nurses and long-term stagnation in scientific research in nursing forced, especially developed countries, to develop doctoral studies in this field and then introduce reforms in nursing, which as the outcome given the improvement in the development of health systems, ways of education and science research in nursing. This article discusses the initial perquisites of the quality system for the development of efficient and high-quality doctoral studies at the health oriented faculties in Bosnia and Herzegovina and the region.
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Postoperative delirium (POD) is a frequent postoperative disorder to the sick and elderly, and always has been associated with extended of day stay in hospital, and certainly more cost for the hospital as well. Additionally, delirium is associated with increased postoperative complications, longer length of stay, longer intensive care unit stay (ICU), and much higher rates of discharge to a nursing home. As a result, delirium adds significant cost to hospitalization and subsequent medical care. The delirium causes an increased mortality and an increasing of mental status deterioration characterized by reduction of environmental recognition as well as the disorder of alertness. The purposes of this study are: a) the effectiveness of routine screening of postoperative Delirium in the elderly using Confusion Assessment Method (CAM)). In those cases psychiatrists are not necessary; b) understanding of risk factors and strategies for prevention and treatment; c) understanding of the impact of this psychotic disorders in postoperative morbidity and mortality; d) recognition of the economic impact of these disorders in the health service; e) describing of the etiology and incidence of Delirium post-operative. ⋯ Postoperative Delirium occurs as a result of the combination of several factors, not just those related to internal physiological age, but combining of these factors with the diseases which carries this age, with medications used for this age, with surgical stress, with biochemical imbalances, hemodynamic problems, and electrolytic disorders as well.
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For almost 100 years, standard procedure for evaluation of axillary lymph status has been axillary nodes dissection (ALDN)-dissection of 1st, 2nd or possible 3rd level of axilla. Use of less invasive evaluation methods of axillary node pathologically (PH) status of non-invasive breast carcinoma has been started before about 30 year and that new method has been named sentinel lymph node biopsy (SLNB). ⋯ Results of sensitivity (68%), specificity (98%), positive (67%) and negative predictive value (96%) and overall accuracy of method (98%) are comparable and compatible with results from oncological breast cancer centers and allow introducing of SLNB in routine surgical practice in our clinical practice as the alternative for ALND for T1 and T2 breast carcinoma. It also contributes to better co-ordination between specialist of nuclear medicine, surgeon and pathologist.
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Randomized Controlled Trial
Glucosa-Insulin-Potassium (GIK) solution used with diabetic patients provides better recovery after coronary bypass operations.
Tight blood glucose control has become a therapeutical goal for anesthetic management for patients scheduled for cardiac surgery, especially if they are diabetic patients. ⋯ Intraoperative GIK solution given to diabetic patients with CABG operation provides more stable CI, shorter time of MV, more stable values of potassium which provides normal rhythm and less AF onset, less insulin to maintain target glycemia. All the above mentioned provides more stable intraoperative hemodynamic and better recovery of diabetic