Browsing by Author "Milić, Ljiljana (37861945500)"

Background: Due to the complexity of health system reform in the post-conflict, post-disaster, and development settings, attempts to restructure health services are fraught with pitfalls that are often unanticipated because of inadequate preliminary assessments. Our proposed Integrated Multimodal Assessment - combining quantitative and qualitative methodologies - may provide a more robust mechanism for identifying programmatic priorities and critical barriers for appropriate and sustainable health system interventions. The purpose of this study is to describe this novel multimodal assessment using emergency medicine in post-conflict Serbia as a model. Methods: Integrated quantitative and qualitative methodologies - system characterization and observation, focus group discussions, free-response questionnaires, and by-person factor analysis - were used to identify needs, problems, and potential barriers to the development of emergency medicine in Serbia. Participants included emergency and pre-hospital personnel from all emergency medical institutions in Belgrade. Results: Demographic data indicate a loosely ordered network of part-time emergency departments supported by 24-hour pre-hospital services and an academic emergency center. Focus groups and questionnaires reveal significant impediments to delivery of care and suggest development priorities. By-person factor analysis subsequently divides respondents into distinctive attitudinal types, compares participant opinions, and identifies programmatic priorities. Conclusions: By combining quantitative and qualitative methodologies, our Integrated Multimodal Assessment identified critical needs and barriers to emergency medicine development in Serbia and may serve as a model for future health system assessments in post-conflict, post-disaster, and development settings. © 2005 Nelson et al; licensee BioMed Central Ltd.

Introduction/Objective The objective was to explore whether there is a difference in headache manifestation and level of its intensity in patients with functional dyspepsia and irritable bowel syndrome. Methods We assessed a cohort of 420 participants out of which 300 satisfied the recruiting criterion of the presence of irritable bowel syndrome (148) or functional dyspepsia (152). Diagnoses of irritable bowel syndrome and functional dyspepsia were made according to Rome IV criteria. Intensity of headaches was estimated in irritable bowel syndrome and functional dyspepsia participants using visual analog scale. All the patients underwent subsequent testing by Hamilton’s Depression Inventory and anxiety scale. Results Our results showed that males with headaches are more susceptible to functional dyspepsia, statistical significance in the group of patients with irritable bowel syndrome with high scores on the visual analog scales, in relation to Hamilton’s anxiety scores in the group of patients with irritable bowel syndrome. Gender and visual analogue scale scores were determinants to show whether the patient falls within the group of functional dyspepsia or irritable bowel syndrome. Scores of visual analogue scale where the patient felt the best was statistically borderline (p = 0.061) and its higher values pinpointed which of those patients fall into irritable bowel syndrome group. Conclusion Gender and level of headache intensity as a extraintestinal manifestation showed to be the main variables to make a difference between patients with functional dyspepsia and irritable bowel syndrome where irritable bowel syndrome had higher scores and greater dominance in differential diagnosis if the headache was determining variable. © 2023, Serbia Medical Society. All rights reserved.

Introduction/Objective The aim of this study is to identify and evaluate the use of New Mobility Score (NMS) in estimating functional recovery three months after total hip arthroplasty (THA). Methods In total, 70 patients, aged > 60 years, underwent THA. Treatment group was subjected to the comprehensive rehabilitation program and control group to the standard one. Primary outcome was assessed with Harris Hip Score (HHS) and NMS, and secondary one by Medical Outcomes Health Survey (Short-Form Health Survey – SF-36). Questionnaires were collected before and three months after hip surgery. Results Treatment group showed significant improvement three months postoperatively. The correlation in both groups between HHS and NMS was very strong (r > 0.700). Treatment group following surgery showed strong correlation between Recovery through Personal Care Services (PCS) and HHS and NMS (r > 0.700), moderate to strong between pain categories and HHS (r = 0.380; r = 0.583) and NMS (r = 0.424). Control group showed strong correlation between PCS and HHS (r = 0.704), and NMS (r = 0.568) and moderate to pain categories and HHS (r = 0.546; r = 0.466). The area under the curve (AUC) described the inherent validity of all measurement used AUCNMS = 0.724, p = 0.001, AUCHHS = 0.788, p = 0.000 and AUCPCS = 0.747, p = 0.001. Conclusion The NMS could be successfully used in routine clinical assessment of elderly patients following THA. The trial is registered in ISRCTN Register with https://doi.org/10.1186/ISRCTN73197506. © 2022, Serbia Medical Society. All rights reserved.

Background: Intra-abdominal infection in secondary peritonitis drives as excessive production of inflammatory mediators and the development of systemic inflammatory response syndrome (SIRS) or sepsis. Finding a specific marker to distinguish SIRS from sepsis would be of immense clinical importance for the therapeutic approach. It is assumed that high-mobility group box 1 protein (HMGB1) could be such a marker. In this study, we examined the time course changes in the blood levels of HMGB1, C-reactive protein (CRP), procalcitonin (PCT) and serum amyloid A (SAA) in patients with secondary peritonitis who developed SIRS or sepsis. Methods: In our study, we evaluated 100 patients with diffuse secondary peritonitis who developed SIRS or sepsis (SIRS and SEPSIS group) and 30 patients with inguinal hernia as a control group. Serum levels of HMGB1, CRP, PCT, and SAA were determined on admission in all the patients, and monitored daily in patients with peritonitis until discharge from hospital. Results: Preoperative HMGB1, CRP, PCT and SAA levels were statistically highly significantly increased in patients with peritonitis compared to patients with inguinal hernia, and significantly higher in patients with sepsis compared to those with SIRS. All four inflammatory markers changed significantly during the follow-up. It is interesting that the patterns of change of HMGB1 and SAA over time were distinctive for SIRS and SEPSIS groups. Conclusions: HMGB1 and SAA temporal patterns might be useful in distinguishing sepsis from noninfectious SIRS in secondary peritonitis. © 2017 Ljiljana Milić et al., published by De Gruyter Open.

Background: Intra-abdominal infection in secondary peritonitis drives as excessive production of inflammatory mediators and the development of systemic inflammatory response syndrome (SIRS) or sepsis. Finding a specific marker to distinguish SIRS from sepsis would be of immense clinical importance for the therapeutic approach. It is assumed that high-mobility group box 1 protein (HMGB1) could be such a marker. In this study, we examined the time course changes in the blood levels of HMGB1, C-reactive protein (CRP), procalcitonin (PCT) and serum amyloid A (SAA) in patients with secondary peritonitis who developed SIRS or sepsis. Methods: In our study, we evaluated 100 patients with diffuse secondary peritonitis who developed SIRS or sepsis (SIRS and SEPSIS group) and 30 patients with inguinal hernia as a control group. Serum levels of HMGB1, CRP, PCT, and SAA were determined on admission in all the patients, and monitored daily in patients with peritonitis until discharge from hospital. Results: Preoperative HMGB1, CRP, PCT and SAA levels were statistically highly significantly increased in patients with peritonitis compared to patients with inguinal hernia, and significantly higher in patients with sepsis compared to those with SIRS. All four inflammatory markers changed significantly during the follow-up. It is interesting that the patterns of change of HMGB1 and SAA over time were distinctive for SIRS and SEPSIS groups. Conclusions: HMGB1 and SAA temporal patterns might be useful in distinguishing sepsis from noninfectious SIRS in secondary peritonitis. © 2017 Ljiljana Milić et al., published by De Gruyter Open.