Family Medicine has always been regarded as an interdisciplinary specialty, but lately, in most Eastern-European countries, such as Romania, it has been supported by many laws and regulations. The outcome of this prolific background has brought both advantages and disadvantages. Some advantages relate to a sustainable structure, and, at the same time, Family Medicine has been recognized as being the gate-keeper in almost any health care system. Further, due to the privatization of most family practice offices, in Romania, appeared a modern organizational approach, in the shape of a consortium of family physician practices. Some family physicians consider providing their services in a private office as a benefit, but for others the freedom and autonomy to become responsible of their own practice is considered to be a drawback because, apart from the clinical activity, many family physicians have to deal with managerial and marketing issues. In Romania, a consortium of family practice offices has to overcome a very competitive environment and some Marketing specific trends. The aim of this paper is to investigate the usefulness of marketing strategies in the Romanian family physician practice.
This study aims to analyze the 25-hydroxyvitamin D (25OHD) corelations with TRab (anti-TSH receptor Antibodies) at baseline and after corections of 25OHD deficit. Method: Prospective, interventional, controled, single-centre, clinical study on 62 patients with active Basedow disease (BD), admitted at C.I. Parhon National Institute of Endocrinology, Bucharest, Romania, between 2013 and 2020. Patients were divided into two groups: one group (N=37) received 2000 IU of daily cholecalciferol and a second one (N=25) without vitamin D supplementation, all subjects being under anti-thyroid drugs (standard guideline therapy). 25OHD and TRab levels were assessed at start and after 6, respective 12 months. Results: Initial evaluation confirmed vitamin D deficiency (mean 25OHD of 18.33±6.45 ng/mL). At start, TRab negatively correlates with 25OHD (N=62, r= -0.22, p=0.08). The decrease in TRab was statistically significant higher in group 1 versus group 2 after 6 months (35.84% versus 3.53%, p=0.03). After 12 months, TRab decreased with 56.28% in group 1, respective 27.16% in group 2 (p=0.03). In group 1, inverse correlation between 25OHD and TRab was consistent at 6 and 12 months. Conclusion: In patients with active BD, TRab values were negatively correlated with 25OHD at baseline and during follow-up. Correction of vitamin D deficiency is correlated with the decrease of TRab levels.
The current paper describes the protocol used in our clinic for 3D imaging, reconstruction and printing of complex acetabular defects that are used for surgical planning of complex acetabular defects. Surgical guides have also been developed to aid optimal acetabular reamer placement in order to recreate the optimal hip rotation centre for each patient undergoing revision hip arthroplasty that has impaired acetabular bone stock.
The biological agent most likely to be used as a biological weapon is Bacillus anthracis, which causes the anthrax infectious disease. During the Cold War, it was present in large quantities in the military arsenals of some states, and at the beginning of the 21st century was used in a series of small bioterrorist attacks. In case of occurrence of events using Bacillus anthracis, urgent and adequate qualitative and quantitative response measures are needed to manage the consequences of the attack and to reduce the effects on public health. These include complex and well-coordinated activities to ensure medical intervention for the prophylaxis, treatment and recovery of patients. General prophylaxis is achieved by vaccination, individual and collective CBRN protection, decontamination, partial and total sanitary treatment, microbiological analysis for the detection, identification and confirmation of the biological agent. Therapy for disease induced by weaponized B. anthracis differs from classic antrax disease regarding antibiotics, doses and time, resulting a large antibiotic consumption per case. Complete recovery of the patients is achieved not only in terms of restoring normal biological parameters, but also in terms of the organism’s "sterilisation" regarding the causal biological agent.
Background: The number of studies with the application of scales, such as Attitudes Toward Obese Persons Scale (ATOP), on morbid obese patients are limited. Therefore, we wanted to examine the attitudes toward obese people through the eyes of morbid obese patients. Methods: Between October 2019 - April 2020, 70 female and 20 male, morbid obese patients, who were admitted to the general surgery department to be evaluated for bariatric surgery were included in this study. These 90 morbid obese patients were asked to fill out ATOP, which included 20 statements. Results: The mean ATOP score of all morbid obese patients was 63.44±18.58 (range:19-116). The mean ATOP score of female patients was 63.47±20.34 (range:19-116), whereas the mean ATOP score of male patients was 63.35±10.69 (range:43-80) (p=0.98). The frequency of the responses given by the male and female patients to the third statement, which was “Most obese people are more self-conscious than other people” pointed out a statistically significant difference (p=0.02). Conclusions: Based on ATOP scores gained from morbid obese patients, 60% of morbid obese patients did not feel as happy as non-obese people, whereas 74.4% of the morbid obese patients thought that obese people were not as healthy as non- obese people. Moreover, ATOP scores which were slightly higher than 60 points in both female and male morbid obese patients indicated that morbid obese patients had neither negative nor highly positive attitudes toward obese people.
Background: The most frequently encountered complication of anastomotic surgery is fistula. In addition to the medical history of the patient, local conditions, the operative moment and surgical technique that were chosen, a series of some other factors can interfere, leading to suture disunity. Aim: The aim of the study was to analyze the existence of a relationship between the use of cecostomy (as a mechanism of temporary diversion) and the frequency of anastomotic fistulas. Materials and methods: We conducted a retrospective study, over a period of 7 years, between 2011-2018 taking into consideration 194 patients who benefited from resections completed with anastomoses in the transverse colon, descending colon, sigmoid and rectum. They were divided into two categories: patients who benefited from cecostomy and patients for whom we did not use this technique. The frequency of fistulas was analyzed for the two main groups and in association with each type of surgery. Results: It was observed the existence of a relationship between the appearance of fistulas and the use of a decompression mechanism such as cecostomy in the sense of a lower number of fistulas for the first situation (2.66%) compared to 11.76% for cases without cecostomy (p=0.034). The duration of hospitalization in the group with cecostomy was shorter than in those without this derivative stoma and the postoperative recovery was good. Conclusions: Cecostomy is a useful protection for the anastomosis line, with the advantage that, when the tube is suppressed, the stoma will spontaneously close.
The diagnosis in Carpian tunnel syndrom is based on clinical symptoms and electrodiagnostic studies. Electrodiagnostic studies help to stage both motor and sensory nerve damage.
Background: Human resource is the most important criteria of today organizations. In considering a human resource, performance and productivity are very fundamental. One of the most important criteria that affect human resources is leadership style. Aims: This study aimed to assess the effect of leadership style (Autocratic, Democratic, and Laissez-faire) on productivity that in this relationship two phenomena (job promotion opportunity and job description) plays the roles of moderating variable. Methods: The data were collected through the distribution of standard questionnaires among 170 employees of a hospital in Tehran and analyzed with structural equation methods with smart PLS software. The reliability and validity of questionnaires are confirmed through software examination and elites' opinions. For examining the hypothesis, factor loading and path coefficient are considered. Results: Democratic and laissez-faire styles have a significant effect on productivity (with 5.51 and 2.65 loading factor and positive path coefficient), but the autocratic style has a negative effect (due to 5.54 loading factor and -0.35 path coefficient) on productivity. Neither job promotion opportunity nor job description plays the role of moderating variables according to the results of the analyzes. Conclusion: Leadership style has a significant impact on productivity. The autocratic style has a negative effect on productivity, but democratic and laissez-faire have a positive effect. Job promotion opportunities and job descriptions don’t play a moderating role in leadership style and productivity relationships.
The individual values of combatants determine life goals, how to achieve them, and perform an important adaptive and protective function under conditions of combat stress. Understanding them enables mental health professionals to create an effective system of Combat and Operational Stress Control for military personnel. The purpose of this research was to determine the personal value sphere typology of individual values of combatants of the War in Eastern Ukraine, and, on its basis, to predict the vector of PTSD development. The value sphere (Rokeach Value Scale) and peculiarities of mental status (“Traumatic Stress Questionnaire”) of nine hundred forty three Ukrainian combatants were investigated. Cluster analysis made it possible to create a typology of combatants' values, consisting of five types: “Passionary”, “The one who does not leave the comfort zone”, “Romantic”, “Formal military man”, “Routine”. The most resistant to combat stress are combatants who are aimed at interiorizing values, expanding the boundaries of existing norms, and public recognition (“Passionary” (2.19%), “Romantic” (3.82%)), and the most vulnerable are those who are “Routine” (15.30%) and “Formal military man” (4.37%). The majority of Ukrainian combatants have a defined type of “The one who does not leave the comfort zone” type (74.32%). For them, safety and well-to-do life are the main priorities.
Commentary
Major radiological threats and emergencies requiring public health preparedness (the example of Greece)
Athanasios Zafeirakis, Ioannis Galatas