Ljubljana University Medical Centre Research Articles

Cost of Diagnosing and Treating Cognitive Complaints: One-year Cost-evaluation Study in a Patient Cohort from a Slovenian Memory Clinic.

IntroductionDementias present a global health challenge and give rise to significant economic costs. This study aims to evaluate the economic impact of one-year outpatient healthcare, nursing home, and formal and informal home help costs for all patients referred to the Centre for Cognitive Impairments at the Department of Neurology, Ljubljana University Medical Centre, Slovenia.MethodsData was acquired retrospectively from physicians’ records and the costs for 2015 were calculated. Total costs were estimated by means of a bottom-up calculation of outpatient visits, diagnostic examinations and anti-dementia medication. In a subgroup of 120 patients with dementia, the Resource Utilization in Dementia questionnaire was used to estimate formal and informal care costs.ResultsA total of 720 patients visited the memory clinic in 2015. Diagnosis at first visit was subjective cognitive or mild cognitive impairment (SCI/ MCI) for 322 patients, dementia for 258 patients, and psychiatric or other disorders for 140 patients. The average annual cost per patient was EUR 578. It was highest for patients with dementia (EUR 751), EUR 550 for patients with SCI/MCI, and lowest for patients with psychiatric and other disorders (EUR 324). Monthly informal and social care costs were between EUR 1,037 and EUR 3,369, depending on the methodology used.ConclusionThe cost of diagnosing a cognitive disorder depends on how extensive the diagnosis is. With an estimated prevalence of 34,137 persons with dementia in Slovenia, basic diagnostic investigations incur costs of approximately EUR 7 million. Direct medical costs represent a smaller portion of total dementia costs; this is because annual costs for formal and informal home help are estimated at EUR 265 million and nursing home placements at EUR 105 million.

Effectiveness of Magnetic Stimulation in the Treatment of Urinary Incontinence: A Systematic Review and Results of Our Study.

Urinary incontinence (UI) is becoming an increasingly common health problem. UI treatment can be conservative or surgical. This paper focuses on the effectiveness of magnetic stimulation (MS) in the treatment of UI. We performed a systematic review in order to combine and compare results with results from our clinical study. A clinical prospective non-randomized study was carried out at the Ljubljana University Medical Center’s Gynecology Division. It included 82 randomly selected female patients, irrespective of their UI type. The success rate of using MS in treating UI was based on standardized ICIQ-UI SF questionnaires. Patients completed 10 therapy sessions on MS, and follow-up was performed 3 months after the last therapy session. UI improved after treatment with MS. The ICIQ-UI SF score improved in patients regardless of the type of UI. However, the greatest decrease in post-treatment assessment ICIQ-UI SF scores was seen in patients with stress urinary incontinence (SUI). Based on the findings described above, it can be concluded that MS is a successful non-invasive conservative method for treating UI. Future studies are necessary, all of which should include a large sample size, a control group, an optimal research protocol, pre-treatment analyses, standardization, and longer follow-ups.

The impact of heatwaves on ED visits at Ljubljana University Medical Center, from 2013 to 2017

Abstract Background Morbidity increases during the summer heatwaves globally. Despite increasing heat load, public health efforts probably improve public awareness and behavior. Our study aimed to assess whether ED visits during heatwaves in Slovenia decreased in the last years. Patients and Methods We analyzed data from the Ljubljana University Medical Centre database for consecutive patients arriving at ED, covering the Osrednjeslovenska region (around 650.000 people) in the summer period 2013 to 2017. We estimated relative risks for a number of ED visits for the observed diagnoses, sex, and age, as well as 95% confidence intervals and excess ED visits associated with heatwaves occurring in all observed years. Results Statistically significant were: in 2013: all, all causes (RT 0.78 (95% IZ, 0,72-0,85)); male, all causes (0.78 (0.70-0.88)); female, all causes(0.77 (0.68-0.87)); 75+ years, all causes (0.79 (0.70-0.91)); all, circulatory system (0.74 (0.63-0.86)); male, circulatory system (0.74 (0.60-0.91)); female, circulatory system (0.74 (0.59-0.93)) and all, digestive system (0.7 (0.35-0.91), in 2014: all, all causes (1.17 (1.07-1.28)); male, all causes (1.14 (1.01-1.29)); female, all causes (1.2 (1.06-1.35)) and all, 75+ years, all causes (1.21 (1.06-1.38)), in 2015: all, all causes (1.08 (1.01-1.16)); female, all causes (1.1 (0.01-1.22)); all, endocrine diseases (1.47 (1.03-2.1)), in 2016: all, all causes (0.92 (0.86-0.98)) and all, 75+ years, all causes (0.9 (0.81-0.99), in 2017: all, 75+ years, all causes (0.89 (0.81-0.97)), all, circulatory system (0.86 (0.77-0.96)), female, circulatory system (0.83 (0.7-0.97)); all, digestive system (0.76 (0.32-0.93)) and all, endocrine diseases (1.38 (1.02-1.85)). Conclusions The scientific evidence shows that it is possible to influence heat-related outcomes with proper public health interventions. The results of our research show a decrease in ED visits during heatwaves and support the hypothesis that public behavior is changing. Key messages ED visits due to heatwaves can be preventable. In Slovenia we are on good way with public health interventions. Heatwaves will become more frequent, more intense and will last longer, so we must continue with public health efforts.

Clinical outcome is associated with the Urinary Tract Dilatation Classification System grade

AimTo assess the association between the Urinary Tract Dilatation (UTD) Antenatal (A) and Postnatal (P) Classification System grade and the outcome in term newborns.MethodsThis retrospective study enrolled 166 term newborns (71% boys, 206 ureterorenal units) evaluated for unilateral or bilateral UTD in the Neonatology Department of Ljubljana University Medical Center from 2012 to 2018. Data on family history, sex, gestational age, birth weight, head circumference, Apgar score, possible oligohydramnios, indication for and age at first postnatal ultrasound, time of follow-up, and clinical outcome were collected. Radiology records were reviewed to grade UTD according to the Multidisciplinary Consensus on the Classification of Prenatal and Postnatal UTD.ResultsThe majority of ureterorenal units with UTD A 2-3 had UTD P 2 or 3. Spontaneous resolution, specific uropathy, the need for surgery, and the risk of urinary tract infection were all significantly associated with UTD P grade. No patient experienced renal dysfunction at the end of follow-up (12-48 months, median 24 months), and therefore this parameter was not associated with the UTD P grade.ConclusionsThe UTD grade was associated with the probability of spontaneous resolution, time to its occurrence, specific uropathies, urinary tract infection, and risk for surgery. However, no association with renal dysfunction was established.

The challenge of complex wound healing caused by necrotizing fasciitis after infection of tension-free vaginal transobturator tape (TVT-O) incontinence material

Pelvic organ prolapse with or without stress urinary incontinence (SUI) is a common gynecological condition that occurs predominantly in middle and old age. Tension-free vaginal tape (TVT) technique is a surgical procedure for treatment of female SUI that is used worldwide. Severe complications are extremely rare. The authors present treatment methods with which they have successfully used for such cases. The Ljubljana University Medical Center carried out 2,587 TVT operations for genuine SUI between 1998 and 2017. The authors carried out a retrospective study to determine long-term success. However, in all of these years, they treated only two serious complications involving necrotizing fasciitis. Both patients were 61-years old, the first patient suffered necrotizing fasciitis shortly after her transobturator TVT (TVT-O) procedure, and the second six years after the initial surgery. Both of them had had repeated extensive fasciectomy, soft tissue debridement, and various modern wound dressing changes, and one of them had had negative pressure wound therapy. Severe complications of TVT-O are rare but present a possibility for great morbidity and mortality. Early surgical treatment plays an important role, together with additional medication.

Counselling before first trimester abortion and acceptability of the procedure: results from a Slovenian cross-sectional study

Objectives: In Slovenia, first-trimester abortion is performed at the woman’s request, either surgically under general anaesthesia or medically with mifepristone and misoprostol, in a public hospital. Our study aimed to evaluate pre-abortion counselling and to reveal differences in acceptability and satisfaction with the two abortion methods.Methods: A cross-sectional study was carried out at Ljubljana University Medical Centre between January and June 2015. Women requesting termination of a pregnancy up to 10 weeks’ gestation voluntarily completed an anonymous questionnaire after the procedure and were divided into a surgical and a medical abortion group.Results: Of the 266 women who were invited to take part, 229 accepted; 16.6% chose a surgical abortion, 83.4% a medical abortion. The most frequent reason cited for requesting an abortion was economic/housing problems. Most women who chose a surgical abortion did so because it was faster, whereas most women who chose a medical abortion did so on the advice of a primary care gynaecologist. Women choosing a surgical abortion had more previous pregnancies and presented with a higher gestational age pregnancy. The choice of method was not related to the woman’s age. There were no differences in acceptability of the two procedures. Pain during the procedure was, however, more severe in the medical abortion group (p = .026), along with bleeding, nausea and chills; there were no differences in severity of vomiting, diarrhoea, dizziness or headache between the groups. Women in the surgical abortion group reported higher satisfaction with the method (p < .001). The study revealed a low frequency of pre-abortion contraceptive counselling.Conclusion: The most common reason given for choosing a surgical abortion was the speed of the procedure; for a medical abortion, it was on the advice of a primary care gynaecologist. Satisfaction was higher with the surgical abortion method. There were no differences in general acceptability of the methods.

The combination of AroCell TK 210 ELISA with Prostate Health Index or prostate-specific antigen density can improve the ability to differentiate prostate cancer from noncancerous conditions.

Prostate-specific antigen (PSA) is an established tumour marker for prostate cancer (PCa). Serum thymidine kinase 1 is a possible new marker for the detection of PCa. The aim of the study was to investigate the diagnostic value of the AroCell TK 210 enzyme-linked immunosorbent assay (ELISA) together with free PSA, [-2]proPSA, and Prostate Health Index (PHI) in differentiating PCa from benign urological conditions. Serum samples from 140 patients with PSA values in the range between 2 and 10 µg/L were collected at the Ljubljana University Medical Centre and the Maribor University Medical Centre. Thymidine kinase (TK1) protein levels were determined using the AroCell TK 210 ELISA and PSA-related parameters analysed with commercial assays. Serum TK1 protein, total and free PSA, proPSA, PSA density (PSAD), and PHI levels in patients with confirmed PCa were significantly higher than in patients with benign urological conditions (P < 0.05). Overall, the AroCell TK 210 ELISA results showed a significant correlation with PHI ( r = 0.25, P = 0.0031). Receiver-operating characteristic curve analyses were used to compare the area under the curve (AUC) of TK 210 ELISA, PHI, and PSA density. For PHI, the AUC was 0.73, comparable to those of TK 210 ELISA (0.67) and PSAD (0.66), with no significant differences in pairwise comparisons (PHI vs TK 210 ELISA P = 0.32, PHI vs PSAD P = 0.24, and TK 210 ELISA vs PSAD P = 0.95). The AUC for the combination of TK1 plus PSAD was significantly higher than those for the individual PSA-related biomarkers and marginally PHI, while the AUC for the combination of TK1 plus PHI was significantly higher than those for the individual PSA-related biomarkers except for PHI and marginally for PSAD. Total PSA concentration was the only marker, that was significantly higher in patients with an increasing Gleason grade. These results suggest that TK1 protein determinations together with PHI or PSAD could be a valuable additional tool in PCa management.

Health-related quality of life in Slovenian patients with colorectal cancer: a single tertiary care center study.

BackgroundThe aim of this study was to evaluate the influence of the surgical treatment on Slovenian colorectal cancer patients’ health-related quality of life and to compare the results to the health-related quality of life of the general Slovenian population.Patients and methodsA total of 413 patients with colorectal cancer operated on at the Abdominal Surgery Department at the Ljubljana University Medical Center between January 1st, 2016 and December 31st, 2017 were sent two standardized and validated questionnaires: the EORTC QLQ-C30 version 3 and EORTC QLQ-CR29. The questionnaires were returned by 197 patients.ResultsCompared to the general population, poorer physical (p < 0.001), role (p = 0.002), cognitive (p = 0.021), and social functioning (p < 0.001) with higher frequency of constipation (p < 0.001), diarrhea (p < 0.001), and financial difficulties (p < 0.001) were reported by the colorectal patients. Female patients reported lower cognitive (p = 0.034) and emotional (p = 0.008) functioning, as well as higher frequency of bloating (p = 0.049) and hair loss (p = 0.01). Compared to the younger group of patients, lower physical functioning (p < 0.001) and higher urinary frequency (p = 0.007), urinary incontinence (p = 0.007), buttock pain (p = 0.007), and anxiety regarding body weight (p = 0.031) were detected among the older group of colorectal patients.ConclusionsThe global health status of colorectal patients in Slovenia is comparable to that of the general Slovenian population, but there is a significantly lower level in some of the quality-of-life scales.

Hospital Staff's Risk of Developing Musculoskeletal Disorders, Especially Low Back Pain.

IntroductionHealth-related absenteeism impacts individuals, companies, and society. Its consequences are reflected in the cost of benefits, substitutes, and reduced productivity. Research shows that musculoskeletal disorders (MSDs) are the most common work-related health problem reported by hospital staff. This study determines the groups at the Ljubljana University Medical Centre that are most susceptible to MSDs, especially low back pain.MethodsUsing data from the Health Data Centre of the Slovenian National Public Health Institute and the medical centre, this cross-sectional study analysed absenteeism among medical centre employees. The correlation between MSD / low-back pain risk factors and incidence was determined using logistic regression. An odds ratio was calculated to determine the probability of MSDs, most especially low back pain via sex, age, occupation, and education.ResultsSick leave at the medical centre is higher than 5%, exceeding the Slovenian healthcare sector average. MSDs, as the main reason for absence, is significantly more frequent in women, non-medical staff, and employees with a maximum secondary school education. Among the MSDs, low back pain predominates as a reason for absence and is most frequent among nurses, midwives, and employees of 20 to 44.9 years old.ConclusionThis study offers insight into the health status of medical centre employees. The high percentage of sick leave is mainly due to musculoskeletal disorders, including low back pain. This is an important basis for further monitoring and analysis of sick leave indicators and for planning systematic and continuous workplace health-promoting measures to manage ergonomic risk factors and reduce health-related absenteeism.

Validity of Klotho, CYR61 and YKL-40 as ideal predictive biomarkers for acute kidney injury: review study.

Acute kidney injury (AKI) is still a headache for clinicians and scientists as a possible reason for increased death among intensive care unit (ICU) patients after invasive cardiac surgery. Furthermore, the diagnostic process for AKI using conventional biomarkers is not sufficient to ensure early warning of this condition because of the morbid influence of non-renal factors that definitively delay the time for the prognosis. These imposed limitations have led to significant amounts of research targeted towards identifying novel biomarkers for AKI with a sustained degree of sensitivity and specificity. Here, we reviewed previous studies conducted on the Klotho, CYR61 and YKL-40 biomarkers in relation to AKI. Review of the literature conducted in the Institute of Clinical Chemistry & Biochemistry, Ljubljana University Medical Center, Slovenia. The literature was searched in PubMed and the Cochrane Library. From the database of this specialty, we selected 17 references that matched our context for detailed analysis and further investigation. The studies reviewed showed notable differences in their results relating to the diagnostic impact of Klotho, CYR61 and YKL-40 on early prediction of AKI. The results regarding the Klotho, CYR61 and YKL-40 biomarkers showed markedly equivocal performance in the previous studies and did not fulfill the expectations that these factors would form valid possible biomarkers for AKI.

Razvoj radiologije na Slovenskem

Few discoveries in the history of science brought such significant progress as did the discovery of X-rays by the German physicist Wilhelm Conrad Röntgen in 1895. The finding did not only bring a revolution to the field of medicine but also to many other technical branches. With technological progress in the 20th century, medical roentgenology swiftly developed. The first significant step forward was the introduction of contrast media followed by others including computerised image data management and digital techniques. Medical diagnostics embraced other imaging methods based on other types of energy such as ultrasound and magnetic resonance imaging. The beginnings of roentgenology in the Slovene Lands go back to the year 1900. Bone fractures were the first to be imaged, followed by thoracic imaging and contrast imaging of the gastrointestinal tract. The use of roentgenology spread significantly after World War I, with the implementation in the following years of X-ray machines in all Slovenian hospitals, some spas and sanatoria. Gradually the need for an independent scientific institution emerged, which led to the establishment of the Roentgenological Institute for Slovenia and Istria in Ljubljana in 1923. At the same time radiology was developing also by other Slovenian hospitals.In the 1950s, Slovenian roentgenology increasingly stayed in touch with contemporary international development, updated its equipment and introduced new methods. The modern concept of centralised radiological management, comparable with that of modern European institutions, was realised in Ljubljana in 1973 after the relocation of the Radiological Institute to the new facilities at the Ljubljana University Medical Centre. The first computer tomography machine was installed in 1980, the first ultrasound machine was acquired in 1981, the first digital subtraction angiography (DSA) machine was introduced in 1986 and the first magnetic resonance machine was installed in 1993. The Clinical Radiology Institute, Ljubljana University Medical Centre, performs ambulatory and hospital radiological management at the secondary and tertiary levels for patients from the region of Ljubljana and from the rest of the country. A sophisticated radiology is also at the University Medical Centre Maribor. In the first decade of the 21st century radiology developed particularly quickly, bringing recent developments in international radiology to Slovenia, especially in the field of interventional radiology.

The Development of Slovenian Heart Surgery: Celebrating 50 Years (1958-2008)

The beginnings of Slovenian cardiac surgery reach back to 1958, when the first heart surgery using extracorporeal circulation (ECC) was performed. The 50th anniversary of this event was the impetus for reviewing its developmental path. History of medicine methodology, including analysis of archival materials, documents, and various publications of the Department of Cardiovascular Surgery, Ljubljana University Medical Center, Slovenia. Presentation of the development of Slovenian cardiac surgery from 1958 to 2008. Small countries may not be able to contribute great developmental steps to world cardiac surgery, but the work of individuals from these countries can represent a contribution to the development of the discipline.

Improved Outcome of Patients with Colorectal Cancer: The Ljubljana University Medical Centre Experience

Background/Aims: Analysis of outcome in patients undergoing resection for colorectal carcinoma. Methods: Between 1/1/1991 and 31/12/2000, 1,478 patients with a colon and rectal carcinoma underwent a potentially curative resection. The results were analyzed for two groups of patients given different treatment regimens during two consecutive 5-year periods. The 5-year survival rate was estimated by the Kaplan-Meier method. Results: Over a period of 10 years, 1,478 patients were treated by resection. The 5-year survival rate for R0 resected patients with stage I and stage III colon cancer in the period 1996–2000 was significantly higher than for patients operated on between 1991 and 1995 (stage I: 86 vs. 70%; stage III: 58 vs. 40%). Similarly, the 5-year survival rate for R0 resected patients with stage III rectal cancer between 1996 and 2000 was significantly better than that for patients operated on during the early period (58 vs. 31%). Conclusions: Patients who underwent R0 resection for colorectal cancer during the period 1995–2000 showed a significantly improved 5-year survival rate compared to those operated on between 1991 and 1995. Improved survival in these patients is to a great extent attributable to improvements in clinical practice combining surgery and adjuvant therapy.

DRUG POISONING IN SLOVENIA

BACKGROUND The Slovenian Register of Intoxications managed by the Poison Control Centre at LjubljanaUniversity Medical Centre was established in 2001. It offers a continuous review ofpoisoning in Slovenia. Our aim was to study the epidemiology of acute drug poisoning inadult patients admitted to hospitals in Slovenia. METHODS We analyzed the data of reported acutely poisoned patients older than 16 years who weretreated in hospitals in Slovenia between 2001 and 2005. RESULTS A total of 1,838 adult acutely poisoned patients were reported to the Register of Intoxicationsbetween 2001 and 2005, of whom 1,234 (67 %) were poisoned by drugs. 67 % ofpatients poisoned by drugs were women and 76 % of patients ingested drugs at home 85 % of patients ingested drugs in suicide attempts. Anxyolytics, hypnotics, sedatives, antipsychoticsand antidepressants represented 68 % of all ingested drugs due to self-poisoning.Drugs for the musculo-skeletal system and drugs for the cardiovascular system followedpoisoning by these drugs. There were 6 benzodiazepines and related drugs betweenthe 10 most commonly ingested drugs due to self-poisoning. The most common signs ofacute drug poisoning were somnolence and coma (75 %). A gastric lavage was performedin 64 % of patients, active charcoal was given to 73 % of patients and 35 % of patients weretreated with an antidote. CONCLUSIONS Poisoning by drugs for the nervous system, particularly benzodiazepines, is the most commonform of poisoning by drugs in Slovenia. It would be necessary to report all acutelypoisoned patients to the Register of Intoxications, since we need data about all poisoningin Slovenia to improve their prophylaxis and treatment

8. Can we recognize threatening eclampsia?

Department of Obstetrics and Gynecology, Division of Perinatology, Ljubljana University Medical Centre, Zaloška 2. SI-1000 Ljubljana