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Kragujevac, Serbia

Stojadinovic M.M.,Clinical Center Kragujevac | Pejovic T.,General Hospital Gornji Milanovac
European Journal of Gastroenterology and Hepatology | Year: 2015

Objectives: The aim of this study was to develop and compare the predictive accuracy of classification and regression tree (CART) analysis with logistic regression (LR) for predicting common bile duct stones (CBDS) in patients subjected to laparoscopic cholecystectomy. Patients and methods: We prospectively collected preoperative (demographic, biochemical, ultrasonographic) and intraoperative (intraoperative cholangiography, cystic duct diameter) data for 154 patients considered for elective laparoscopic cholecystectomy at the department of General Surgery at Gornji Milanovac from 2013 through 2014. Univariate and multivariate regression analyses were used to determine independent predictors of CBDS. The CART analysis was carried out using the predictors identified by LR analysis. Various measures for the assessment of risk prediction models were determined, such as predictive ability, accuracy, the area under the receiver operating characteristic curve, and clinical utility using decision curve analysis. Results: The most decisive variable at the time of classification was the cystic duct diameter category, the alkaline phosphatase, and dangerous stones. The CART model was shown to have good discriminatory ability (93.9%). Accuracy was similar in both models, ranging from 92.9% in the CART model and 93.5% in the LR model. In decision curve analysis, the CART model outperformed the LR model. Conclusion: We developed a user-friendly risk model that can successfully predict the presence of choledocholithiasis in patients planned for elective cholecystectomy. However, before recommending its use in clinical practice, a larger and more complete database should be used to further clarify the differences between models in terms of prediction of the CBDS. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved. Source

Vasic L.,Clinical Center Kragujevac
Medicinski pregled | Year: 2010

Despite the availability of an efficient screening protocol review, colon cancer is a leading health problem of the world population. At the time of diagnosis about 25% of cases have distant metastases. Distant metastases are most frequently metastases in the liver, lungs, brain, but they are rare in the bones. An early diagnosis of secondary deposits in the bones of the hand can be very difficult. The symptoms are subclinical or similar to other bone diseases. They appear in the advanced disease, and treatment is palliative. The treatment (radiotherapy, chemotherapy, surgery) is determined according to the general condition of the patient and the localization of the lesion. Radiotherapy can reduce tumor mass and reduce pain especially among patients with multiple lesions or inoperable ones. The aim of this paper was to: (1) present a case of secondary deposits of adenocarcinoma of the colon in the hand bones, (2) present the incidence, (3) give differential diagnoses and (4) describe the air treatment by unconventional regime of fractionation. The approach to the treatment of metastatic hands must be multi-disciplinary including an orthopedist, radiologist, oncologist and pathologist. It is important to know the importance of early recognition of these lesions. Source

Jakovljevic M.,University of Kragujevac | Zugic A.,University of Kragujevac | Rankovic A.,Clinical Center Kragujevac | Dagovic A.,Oncology and Radiotherapy Center
Journal of Medical Economics | Year: 2015

Objective: Current radiation therapy capacities in Serbia and most of Eastern Europe are heavily lagging behind population needs. The primary study aim was assessment of direct costs of cancer medical care for patients suffering from cancer with assigned radiotherapy-based treatment protocols. Identification of key cost drivers and trends during 2010-2013 comparing brachytherapy and teleradiotherapy was a secondary objective of the study.Methods: Retrospective, bottom-up database analysis was conducted on electronic discharge invoices. Payer's perspective has been adopted with a 1-year long time horizon. Total sample size was 2544 patients during a 4-years long observation period (2010-2013). The sample consisted of all patients with confirmed malignancy disorder receiving inpatient radiation therapy in a large university hospital.Results: Diagnostics and treatment cost of cancer in the largest Western Balkans market of Serbia were heavily dominated by radiation therapy related direct medical costs. Total costs of care as well as mean cost per patient were steadily decreasing due to budget cuts caused by global recession. The paradox is that at the same time the budget share of radiotherapy increased for almost 15% and in value-based terms for €109 per patient (in total €109,330). Second ranked cost drivers were nursing care and imaging diagnostics. Costs of high-tech visualizing examinations were heavily dominated by nuclear medicine tests.Conclusion: The budget impact of radiation oncology to the large tertiary care university clinics of the Balkans is likely to remain significant in the future. Brachytherapy exhibited a slow growth pattern, while teleradiotherapy remained stable in terms of value-based turnover of medical services. Upcoming heavy investment into the national network of radiotherapy facilities will emphasize the unsatisfied needs. Huge contemporary budget share of radiotherapy coupled with rising cancer prevalence brings this issue into the hot spot of the ongoing cost containment efforts by local governments. © 2015 Informa UK Ltd. Source

Loncar D.,Clinical Center Kragujevac
Medicinski Casopis | Year: 2014

Objective. This study investigated the presence of risk factors for oral disease by evaluating oral hygiene habits among pregnant women. Methods. The study included 45 pregnant women during the 8th-38th weeks of gestation that answered a questionnaire about the habits in oral hygiene. The obtained data were processed by using descriptive statistics. Results. Eighty percent of pregnant women maintained their oral hygiene, out of which 64% used only the basic measures and the remaining 36% used some of the additional treatment strategies (different types of mouthwash, dental floss or interdental brushes). As much as 69% of women attended the dentist only when necessary, only when a problem occurred (pain, swelling). The habit of teeth brushing immediately after vomiting was found in 69% of women. The total of 45% of women took less than three minutes a day to maintain their oral hygiene. Approximately 60% of women noticed gum bleeding at the teeth brush during pregnancy. The total of 27% of women confirmed to have taken less attention to oral health during their pregnancy. Only 60% of pregnant women were informed about the importance of oral health during pregnancy and 40% of them had not been informed about the importance of oral health. Conclusion. There should be a continuous process of application of prophylactic and therapeutic, as well as educational and health procedures, in dealing with pregnant women. When it comes to maintaining oral health, it is vital to inform pregnant women using comprehensible and practically applicable advice that will improve their awareness about the importance of oral hygiene. © 2014, Serbian Medical Society. All rights reserved. Source

De Bruyne B.,Cardiovascular Center Aalst | Fearon W.F.,Stanford University | Pijls N.H.J.,TU Eindhoven | Barbato E.,Cardiovascular Center Aalst | And 19 more authors.
New England Journal of Medicine | Year: 2014

BACKGROUND: We hypothesized that in patients with stable coronary artery disease and stenosis, percutaneous coronary intervention (PCI) performed on the basis of the fractional flow reserve (FFR) would be superior to medical therapy. METHODS: In 1220 patients with stable coronary artery disease, we assessed the FFR in all stenoses that were visible on angiography. Patients who had at least one stenosis with an FFR of 0.80 or less were randomly assigned to undergo FFR-guided PCI plus medical therapy or to receive medical therapy alone. Patients in whom all stenoses had an FFR of more than 0.80 received medical therapy alone and were included in a registry. The primary end point was a composite of death from any cause, nonfatal myocardial infarction, or urgent revascularization within 2 years. RESULTS: The rate of the primary end point was significantly lower in the PCI group than in the medical-therapy group (8.1% vs. 19.5%; hazard ratio, 0.39; 95% confidence interval [CI], 0.26 to 0.57; P<0.001). This reduction was driven by a lower rate of urgent revascularization in the PCI group (4.0% vs. 16.3%; hazard ratio, 0.23; 95% CI, 0.14 to 0.38; P<0.001), with no significant between-group differences in the rates of death and myocardial infarction. Urgent revascularizations that were triggered by myocardial infarction or ischemic changes on electrocardiography were less frequent in the PCI group (3.4% vs. 7.0%, P = 0.01). In a landmark analysis, the rate of death or myocardial infarction from 8 days to 2 years was lower in the PCI group than in the medical-therapy group (4.6% vs. 8.0%, P = 0.04). Among registry patients, the rate of the primary end point was 9.0% at 2 years. CONCLUSIONS: In patients with stable coronary artery disease, FFR-guided PCI, as compared with medical therapy alone, improved the outcome. Patients without ischemia had a favorable outcome with medical therapy alone. Copyright © 2014 Massachusetts Medical Society. Source

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