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Biomedical subjects

A Hebrang

Publications and source records attributed to A Hebrang.

44 records · Page 3Linked to original sources
PubMedDate not supplied

[The direction of Croatian health care in the post-war period].

A radical transformation of the health-care system in Croatia has begun after the first free and democratic elections in the country. Changes were initiated along the lines suggested by the World Health Organization experts and in accordance with the positive experiences of the earlier health-care organization and practice. The newly introduced changes involved the introduction of market mechanisms in health care (private medical practice and contracting for medical services), establishment of health insurance funds, formulation of rules and standards for the provision of medical services, and reorganization of management in medical institutions. With the start of the armed aggression against the Republic of Croatia, all of these activities ceased and the health-care system switched very quickly from peace-time to war-time operation. At the same time, preparatory work continued on the definitive reorganization of the health-care and health insurance systems. The present paper discusses the underlying principles for the three basic pieces of legislation: Health Care Act, Professional Chambers Act, and Health Insurance Act. The Health Care Act will be based on new patterns of property relations in health-care organizations. Three types of ownership are envisaged - state, private and mixed. Most of the existing health-care institutions will be state-owned, and the owner (government, district or municipal authority) will appoint a governing board in each case, which, in turn, will appoint the director or manager. A separate piece of legislation will regulate the status of health workers.(ABSTRACT TRUNCATED AT 250 WORDS)

Croatia↗
PubMedDate not supplied

[Analysis of the frequency, types and justification for radiographic examination based on a sample of a community population].

According to the patient's general practitioner files of the Health centre "Josip Adamić" Ivanić-Grad, all x-ray diagnostic examinations carried out in health insured persons of the Ivanić-Grad community were analyzed between 1983 and 1987. During the period, a total of 22,615 x-ray examinations were done. An average number of 0.761 radiographs was performed and the average x-ray dose to which patients were exposed was 126.62 mrads (1.26 mGy). The site of most usual examination was the thorax (44.1%). Males underwent more x-ray examinations than females (53.2% versus 46.8%). X-rays of thorax, head and neck, arms and legs were more frequent in males, while abdomen and pelvis x-ray examinations and diascopies were more usual in females. The greatest number of x-ray examinations was performed between the ages of 0 to 20 years of age, and patients were exposed to the highest x-ray dose between the ages of 41 to 60 years of age. The average gonadal dose was 58.78 mrads (0.58 mGy) per year. Clinical examinations preceded radiologic examinations in 81.3% of cases, laboratory investigations in 9.7% and other non-radiologic examinations in 1.4% of cases. The working diagnosis existed before x-ray examination in 77% of cases and pathological findings were discovered in 32.7% of cases.

Adult↗
PubMedDate not supplied

[The role of intravenous digital subtraction angiography in the detection of the cause of cerebral ischemia].

A comparative analysis of two angiography methods applied in two unrelated groups of patients with brain ischemia symptoms is described. The first group of 452 patients suffering from extracranial cerebral artery disease was analyzed by an intravenous digital subtraction angiography (DSA); the second group of 500 patients was subjected to a conventional aortic arch angiography. Research was based on comparative analysis of angiograms as per type and location of morbid changes. In the area of common carotid artery and internal carotid artery the stenosis was considerably more frequently detected by the conventional angiography than by the intravenous DSA, i.e. in 105 (20.0%) as compared to 40 (8.8%) patients, respectively. Similar difference is indicated in a total number of morbid changes in these arteries detected in 248 patients (49.6%) by aortic arch angiography and in 154 (34.1%) patients by intravenous DSA. The dissimilarity is noticed with minor atherosclerotic changes, while medium and major stenoses are detected with equal frequency by both methods. The intravenous DSA more often indicated flexion of carotid artery, and considerably more often the vertebral artery flexion as found in 53 (11.7%) patients analyzed by intravenous DSA compared to 33 (6.6%) patients analyzed by conventional angiography. Advantage of intravenous DSA is less complications and ambulatory performance. The conventional angiography better indicates morbid changes in common carotid artery bifurcation and vertebral artery origin.

Adult↗
PubMedDate not supplied

[Diagnostic approach in patients with kidney tumors].

The basic reason for the rationalization of diagnostic procedure is the cost benefit relation and making of the diagnostic course algorithms. On the basis of the Receiver Operating Characteristic (ROC) analysis of the diagnostic procedure (excretory urography, ultrasonography, computed tomography, digital subtraction angiography) the significance ranking has been established for certain kidney tumor diagnostic procedures. Angiography has been determined to be the most precise method, but the high degree of sensitivity (98%) and accurate diagnosis probability (98%), as well as noninvasiveness and relative inexpensiveness of ultrasonographic examination procedure, all argue for ultrasonography as the cornerstone, of renal tumor diagnosis. Using conditional probabilities and the Bayes analysis the advantage of the newly suggested over the standard diagnostic course has been calculated. The study has shown a significant decrease in the number of examinations: in 60 patients 16 excretory urographies, 10 computed tomographies, and 22 digital subtraction angiographies can be spared.

Adult↗
PubMedDate not supplied

[The age of diagnostic radiologic equipment in Croatia].

The quality of health care also depends partly on technological equipment. Among the devices which diminish the quality of services if they are old, increasing at the same time the danger when used, are certainly those in radiodiagnostics. Besides, their age controls the dose of radiation to which patients and professional staff are exposed. The knowledge of the age of this equipment is the basis of the plans for further development. The aim of the study is to determine the age of each individual radiodiagnostic device in Croatian institutions. The assessment of each device was made by a qualified professional. The method of data collection was based on the uniform questionnaire which comprised radiodiagnostic devices older than ten years, classified according to type and location (primary health care center or hospital, in total 655 devices). Determination of the age index of generators and x-ray tubes older than seven years (according to the World Bank recommendation), included also mobile units (55 for fluoroscopy and 68 for radiography), devices for dental radiography, devices in private sector (118) and devices which are out of use but not officially blocked (88), which means in total 859 generators and 1111 x-ray tubes. In addition, the availability of image intensifiers for fluoroscopy and manufactures of all devices were determined. The results of the study reveal that in primary health care centers, out of 248 radiodiagnostic devices, 193 are older than ten years (77.8%), while 4 are of unknown age. In hospitals, out of 407 devices, there are 261 older than ten years (64.1%), while 46 are of unknown age (11.3%). Among devices for fluoroscopy, 97 out of totally 206 have no image intensifier (32%). These devices should be immediately excluded from utilization. The index of age above seven years, which is according to the recommendation of the World Bank the lifetime of devices, reveals that 859 generators out of totally 984 (91%) are too old to be used, while there are 1111 x-ray tubes out of totally 1206 (92%) which are in the same condition. Regarding the manufacturers, the ratio is also unfavourable, since 49.3% of devices have been manufactured by comparies whose technology and spare parts are now inaccessible (Elektronska industrija). Such unacceptable obsoleteness of the radiological equipment requires urgent renewal.

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