Kronična rana znatno umanjuje kvalitetu života bolesnika, zahtijeva kontinuiranu lokalnu terapiju, uzrokuje imobilnost bolesnika i u visokom je postotku praćena bolovima.
Potkoljenični ulkus javlja se u 0,6–3 % osoba starijih od 60 godina, a u dobnoj skupini iznad 80 godina taj je broj veći od 5 %.
Kronične rane su rastući socioekonomski problem u razvijenim zemljama i javljaju se u 1-2 % populacije.
Procjenjuje se da će taj broj rasti s obzirom na starenje populacije te porast incidencije dijabetesa i pretilost.
Dijagnostički protokol obuhvata sljedeće korake: glavna poteškoća (smetnja), anamneza (medicinska i stomatološka),
klinički pregled i ispitivanja, analiza podataka – diferencijalna dijagnoza i plan liječenja.
2024 State of Marketing Report – by HubspotMarius Sescu
https://www.hubspot.com/state-of-marketing
· Scaling relationships and proving ROI
· Social media is the place for search, sales, and service
· Authentic influencer partnerships fuel brand growth
· The strongest connections happen via call, click, chat, and camera.
· Time saved with AI leads to more creative work
· Seeking: A single source of truth
· TLDR; Get on social, try AI, and align your systems.
· More human marketing, powered by robots
Dijagnostički protokol obuhvata sljedeće korake: glavna poteškoća (smetnja), anamneza (medicinska i stomatološka),
klinički pregled i ispitivanja, analiza podataka – diferencijalna dijagnoza i plan liječenja.
2024 State of Marketing Report – by HubspotMarius Sescu
https://www.hubspot.com/state-of-marketing
· Scaling relationships and proving ROI
· Social media is the place for search, sales, and service
· Authentic influencer partnerships fuel brand growth
· The strongest connections happen via call, click, chat, and camera.
· Time saved with AI leads to more creative work
· Seeking: A single source of truth
· TLDR; Get on social, try AI, and align your systems.
· More human marketing, powered by robots
ChatGPT is a revolutionary addition to the world since its introduction in 2022. A big shift in the sector of information gathering and processing happened because of this chatbot. What is the story of ChatGPT? How is the bot responding to prompts and generating contents? Swipe through these slides prepared by Expeed Software, a web development company regarding the development and technical intricacies of ChatGPT!
Product Design Trends in 2024 | Teenage EngineeringsPixeldarts
The realm of product design is a constantly changing environment where technology and style intersect. Every year introduces fresh challenges and exciting trends that mold the future of this captivating art form. In this piece, we delve into the significant trends set to influence the look and functionality of product design in the year 2024.
How Race, Age and Gender Shape Attitudes Towards Mental HealthThinkNow
Mental health has been in the news quite a bit lately. Dozens of U.S. states are currently suing Meta for contributing to the youth mental health crisis by inserting addictive features into their products, while the U.S. Surgeon General is touring the nation to bring awareness to the growing epidemic of loneliness and isolation. The country has endured periods of low national morale, such as in the 1970s when high inflation and the energy crisis worsened public sentiment following the Vietnam War. The current mood, however, feels different. Gallup recently reported that national mental health is at an all-time low, with few bright spots to lift spirits.
To better understand how Americans are feeling and their attitudes towards mental health in general, ThinkNow conducted a nationally representative quantitative survey of 1,500 respondents and found some interesting differences among ethnic, age and gender groups.
Technology
For example, 52% agree that technology and social media have a negative impact on mental health, but when broken out by race, 61% of Whites felt technology had a negative effect, and only 48% of Hispanics thought it did.
While technology has helped us keep in touch with friends and family in faraway places, it appears to have degraded our ability to connect in person. Staying connected online is a double-edged sword since the same news feed that brings us pictures of the grandkids and fluffy kittens also feeds us news about the wars in Israel and Ukraine, the dysfunction in Washington, the latest mass shooting and the climate crisis.
Hispanics may have a built-in defense against the isolation technology breeds, owing to their large, multigenerational households, strong social support systems, and tendency to use social media to stay connected with relatives abroad.
Age and Gender
When asked how individuals rate their mental health, men rate it higher than women by 11 percentage points, and Baby Boomers rank it highest at 83%, saying it’s good or excellent vs. 57% of Gen Z saying the same.
Gen Z spends the most amount of time on social media, so the notion that social media negatively affects mental health appears to be correlated. Unfortunately, Gen Z is also the generation that’s least comfortable discussing mental health concerns with healthcare professionals. Only 40% of them state they’re comfortable discussing their issues with a professional compared to 60% of Millennials and 65% of Boomers.
Race Affects Attitudes
As seen in previous research conducted by ThinkNow, Asian Americans lag other groups when it comes to awareness of mental health issues. Twenty-four percent of Asian Americans believe that having a mental health issue is a sign of weakness compared to the 16% average for all groups. Asians are also considerably less likely to be aware of mental health services in their communities (42% vs. 55%) and most likely to seek out information on social media (51% vs. 35%).
AI Trends in Creative Operations 2024 by Artwork Flow.pdfmarketingartwork
This article is all about what AI trends will emerge in the field of creative operations in 2024. All the marketers and brand builders should be aware of these trends for their further use and save themselves some time!
A report by thenetworkone and Kurio.
The contributing experts and agencies are (in an alphabetical order): Sylwia Rytel, Social Media Supervisor, 180heartbeats + JUNG v MATT (PL), Sharlene Jenner, Vice President - Director of Engagement Strategy, Abelson Taylor (USA), Alex Casanovas, Digital Director, Atrevia (ES), Dora Beilin, Senior Social Strategist, Barrett Hoffher (USA), Min Seo, Campaign Director, Brand New Agency (KR), Deshé M. Gully, Associate Strategist, Day One Agency (USA), Francesca Trevisan, Strategist, Different (IT), Trevor Crossman, CX and Digital Transformation Director; Olivia Hussey, Strategic Planner; Simi Srinarula, Social Media Manager, The Hallway (AUS), James Hebbert, Managing Director, Hylink (CN / UK), Mundy Álvarez, Planning Director; Pedro Rojas, Social Media Manager; Pancho González, CCO, Inbrax (CH), Oana Oprea, Head of Digital Planning, Jam Session Agency (RO), Amy Bottrill, Social Account Director, Launch (UK), Gaby Arriaga, Founder, Leonardo1452 (MX), Shantesh S Row, Creative Director, Liwa (UAE), Rajesh Mehta, Chief Strategy Officer; Dhruv Gaur, Digital Planning Lead; Leonie Mergulhao, Account Supervisor - Social Media & PR, Medulla (IN), Aurelija Plioplytė, Head of Digital & Social, Not Perfect (LI), Daiana Khaidargaliyeva, Account Manager, Osaka Labs (UK / USA), Stefanie Söhnchen, Vice President Digital, PIABO Communications (DE), Elisabeth Winiartati, Managing Consultant, Head of Global Integrated Communications; Lydia Aprina, Account Manager, Integrated Marketing and Communications; Nita Prabowo, Account Manager, Integrated Marketing and Communications; Okhi, Web Developer, PNTR Group (ID), Kei Obusan, Insights Director; Daffi Ranandi, Insights Manager, Radarr (SG), Gautam Reghunath, Co-founder & CEO, Talented (IN), Donagh Humphreys, Head of Social and Digital Innovation, THINKHOUSE (IRE), Sarah Yim, Strategy Director, Zulu Alpha Kilo (CA).
Trends In Paid Search: Navigating The Digital Landscape In 2024Search Engine Journal
The search marketing landscape is evolving rapidly with new technologies, and professionals, like you, rely on innovative paid search strategies to meet changing demands.
It’s important that you’re ready to implement new strategies in 2024.
Check this out and learn the top trends in paid search advertising that are expected to gain traction, so you can drive higher ROI more efficiently in 2024.
You’ll learn:
- The latest trends in AI and automation, and what this means for an evolving paid search ecosystem.
- New developments in privacy and data regulation.
- Emerging ad formats that are expected to make an impact next year.
Watch Sreekant Lanka from iQuanti and Irina Klein from OneMain Financial as they dive into the future of paid search and explore the trends, strategies, and technologies that will shape the search marketing landscape.
If you’re looking to assess your paid search strategy and design an industry-aligned plan for 2024, then this webinar is for you.
5 Public speaking tips from TED - Visualized summarySpeakerHub
From their humble beginnings in 1984, TED has grown into the world’s most powerful amplifier for speakers and thought-leaders to share their ideas. They have over 2,400 filmed talks (not including the 30,000+ TEDx videos) freely available online, and have hosted over 17,500 events around the world.
With over one billion views in a year, it’s no wonder that so many speakers are looking to TED for ideas on how to share their message more effectively.
The article “5 Public-Speaking Tips TED Gives Its Speakers”, by Carmine Gallo for Forbes, gives speakers five practical ways to connect with their audience, and effectively share their ideas on stage.
Whether you are gearing up to get on a TED stage yourself, or just want to master the skills that so many of their speakers possess, these tips and quotes from Chris Anderson, the TED Talks Curator, will encourage you to make the most impactful impression on your audience.
See the full article and more summaries like this on SpeakerHub here: https://speakerhub.com/blog/5-presentation-tips-ted-gives-its-speakers
See the original article on Forbes here:
http://www.forbes.com/forbes/welcome/?toURL=http://www.forbes.com/sites/carminegallo/2016/05/06/5-public-speaking-tips-ted-gives-its-speakers/&refURL=&referrer=#5c07a8221d9b
ChatGPT and the Future of Work - Clark Boyd Clark Boyd
Everyone is in agreement that ChatGPT (and other generative AI tools) will shape the future of work. Yet there is little consensus on exactly how, when, and to what extent this technology will change our world.
Businesses that extract maximum value from ChatGPT will use it as a collaborative tool for everything from brainstorming to technical maintenance.
For individuals, now is the time to pinpoint the skills the future professional will need to thrive in the AI age.
Check out this presentation to understand what ChatGPT is, how it will shape the future of work, and how you can prepare to take advantage.
A brief introduction to DataScience with explaining of the concepts, algorithms, machine learning, supervised and unsupervised learning, clustering, statistics, data preprocessing, real-world applications etc.
It's part of a Data Science Corner Campaign where I will be discussing the fundamentals of DataScience, AIML, Statistics etc.
Time Management & Productivity - Best PracticesVit Horky
Here's my presentation on by proven best practices how to manage your work time effectively and how to improve your productivity. It includes practical tips and how to use tools such as Slack, Google Apps, Hubspot, Google Calendar, Gmail and others.
The six step guide to practical project managementMindGenius
The six step guide to practical project management
If you think managing projects is too difficult, think again.
We’ve stripped back project management processes to the
basics – to make it quicker and easier, without sacrificing
the vital ingredients for success.
“If you’re looking for some real-world guidance, then The Six Step Guide to Practical Project Management will help.”
Dr Andrew Makar, Tactical Project Management
Unlocking the Power of ChatGPT and AI in Testing - A Real-World Look, present...Applitools
During this webinar, Anand Bagmar demonstrates how AI tools such as ChatGPT can be applied to various stages of the software development life cycle (SDLC) using an eCommerce application case study. Find the on-demand recording and more info at https://applitools.info/b59
Key takeaways:
• Learn how to use ChatGPT to add AI power to your testing and test automation
• Understand the limitations of the technology and where human expertise is crucial
• Gain insight into different AI-based tools
• Adopt AI-based tools to stay relevant and optimize work for developers and testers
* ChatGPT and OpenAI belong to OpenAI, L.L.C.
ChatGPT is a revolutionary addition to the world since its introduction in 2022. A big shift in the sector of information gathering and processing happened because of this chatbot. What is the story of ChatGPT? How is the bot responding to prompts and generating contents? Swipe through these slides prepared by Expeed Software, a web development company regarding the development and technical intricacies of ChatGPT!
Product Design Trends in 2024 | Teenage EngineeringsPixeldarts
The realm of product design is a constantly changing environment where technology and style intersect. Every year introduces fresh challenges and exciting trends that mold the future of this captivating art form. In this piece, we delve into the significant trends set to influence the look and functionality of product design in the year 2024.
How Race, Age and Gender Shape Attitudes Towards Mental HealthThinkNow
Mental health has been in the news quite a bit lately. Dozens of U.S. states are currently suing Meta for contributing to the youth mental health crisis by inserting addictive features into their products, while the U.S. Surgeon General is touring the nation to bring awareness to the growing epidemic of loneliness and isolation. The country has endured periods of low national morale, such as in the 1970s when high inflation and the energy crisis worsened public sentiment following the Vietnam War. The current mood, however, feels different. Gallup recently reported that national mental health is at an all-time low, with few bright spots to lift spirits.
To better understand how Americans are feeling and their attitudes towards mental health in general, ThinkNow conducted a nationally representative quantitative survey of 1,500 respondents and found some interesting differences among ethnic, age and gender groups.
Technology
For example, 52% agree that technology and social media have a negative impact on mental health, but when broken out by race, 61% of Whites felt technology had a negative effect, and only 48% of Hispanics thought it did.
While technology has helped us keep in touch with friends and family in faraway places, it appears to have degraded our ability to connect in person. Staying connected online is a double-edged sword since the same news feed that brings us pictures of the grandkids and fluffy kittens also feeds us news about the wars in Israel and Ukraine, the dysfunction in Washington, the latest mass shooting and the climate crisis.
Hispanics may have a built-in defense against the isolation technology breeds, owing to their large, multigenerational households, strong social support systems, and tendency to use social media to stay connected with relatives abroad.
Age and Gender
When asked how individuals rate their mental health, men rate it higher than women by 11 percentage points, and Baby Boomers rank it highest at 83%, saying it’s good or excellent vs. 57% of Gen Z saying the same.
Gen Z spends the most amount of time on social media, so the notion that social media negatively affects mental health appears to be correlated. Unfortunately, Gen Z is also the generation that’s least comfortable discussing mental health concerns with healthcare professionals. Only 40% of them state they’re comfortable discussing their issues with a professional compared to 60% of Millennials and 65% of Boomers.
Race Affects Attitudes
As seen in previous research conducted by ThinkNow, Asian Americans lag other groups when it comes to awareness of mental health issues. Twenty-four percent of Asian Americans believe that having a mental health issue is a sign of weakness compared to the 16% average for all groups. Asians are also considerably less likely to be aware of mental health services in their communities (42% vs. 55%) and most likely to seek out information on social media (51% vs. 35%).
AI Trends in Creative Operations 2024 by Artwork Flow.pdfmarketingartwork
This article is all about what AI trends will emerge in the field of creative operations in 2024. All the marketers and brand builders should be aware of these trends for their further use and save themselves some time!
A report by thenetworkone and Kurio.
The contributing experts and agencies are (in an alphabetical order): Sylwia Rytel, Social Media Supervisor, 180heartbeats + JUNG v MATT (PL), Sharlene Jenner, Vice President - Director of Engagement Strategy, Abelson Taylor (USA), Alex Casanovas, Digital Director, Atrevia (ES), Dora Beilin, Senior Social Strategist, Barrett Hoffher (USA), Min Seo, Campaign Director, Brand New Agency (KR), Deshé M. Gully, Associate Strategist, Day One Agency (USA), Francesca Trevisan, Strategist, Different (IT), Trevor Crossman, CX and Digital Transformation Director; Olivia Hussey, Strategic Planner; Simi Srinarula, Social Media Manager, The Hallway (AUS), James Hebbert, Managing Director, Hylink (CN / UK), Mundy Álvarez, Planning Director; Pedro Rojas, Social Media Manager; Pancho González, CCO, Inbrax (CH), Oana Oprea, Head of Digital Planning, Jam Session Agency (RO), Amy Bottrill, Social Account Director, Launch (UK), Gaby Arriaga, Founder, Leonardo1452 (MX), Shantesh S Row, Creative Director, Liwa (UAE), Rajesh Mehta, Chief Strategy Officer; Dhruv Gaur, Digital Planning Lead; Leonie Mergulhao, Account Supervisor - Social Media & PR, Medulla (IN), Aurelija Plioplytė, Head of Digital & Social, Not Perfect (LI), Daiana Khaidargaliyeva, Account Manager, Osaka Labs (UK / USA), Stefanie Söhnchen, Vice President Digital, PIABO Communications (DE), Elisabeth Winiartati, Managing Consultant, Head of Global Integrated Communications; Lydia Aprina, Account Manager, Integrated Marketing and Communications; Nita Prabowo, Account Manager, Integrated Marketing and Communications; Okhi, Web Developer, PNTR Group (ID), Kei Obusan, Insights Director; Daffi Ranandi, Insights Manager, Radarr (SG), Gautam Reghunath, Co-founder & CEO, Talented (IN), Donagh Humphreys, Head of Social and Digital Innovation, THINKHOUSE (IRE), Sarah Yim, Strategy Director, Zulu Alpha Kilo (CA).
Trends In Paid Search: Navigating The Digital Landscape In 2024Search Engine Journal
The search marketing landscape is evolving rapidly with new technologies, and professionals, like you, rely on innovative paid search strategies to meet changing demands.
It’s important that you’re ready to implement new strategies in 2024.
Check this out and learn the top trends in paid search advertising that are expected to gain traction, so you can drive higher ROI more efficiently in 2024.
You’ll learn:
- The latest trends in AI and automation, and what this means for an evolving paid search ecosystem.
- New developments in privacy and data regulation.
- Emerging ad formats that are expected to make an impact next year.
Watch Sreekant Lanka from iQuanti and Irina Klein from OneMain Financial as they dive into the future of paid search and explore the trends, strategies, and technologies that will shape the search marketing landscape.
If you’re looking to assess your paid search strategy and design an industry-aligned plan for 2024, then this webinar is for you.
5 Public speaking tips from TED - Visualized summarySpeakerHub
From their humble beginnings in 1984, TED has grown into the world’s most powerful amplifier for speakers and thought-leaders to share their ideas. They have over 2,400 filmed talks (not including the 30,000+ TEDx videos) freely available online, and have hosted over 17,500 events around the world.
With over one billion views in a year, it’s no wonder that so many speakers are looking to TED for ideas on how to share their message more effectively.
The article “5 Public-Speaking Tips TED Gives Its Speakers”, by Carmine Gallo for Forbes, gives speakers five practical ways to connect with their audience, and effectively share their ideas on stage.
Whether you are gearing up to get on a TED stage yourself, or just want to master the skills that so many of their speakers possess, these tips and quotes from Chris Anderson, the TED Talks Curator, will encourage you to make the most impactful impression on your audience.
See the full article and more summaries like this on SpeakerHub here: https://speakerhub.com/blog/5-presentation-tips-ted-gives-its-speakers
See the original article on Forbes here:
http://www.forbes.com/forbes/welcome/?toURL=http://www.forbes.com/sites/carminegallo/2016/05/06/5-public-speaking-tips-ted-gives-its-speakers/&refURL=&referrer=#5c07a8221d9b
ChatGPT and the Future of Work - Clark Boyd Clark Boyd
Everyone is in agreement that ChatGPT (and other generative AI tools) will shape the future of work. Yet there is little consensus on exactly how, when, and to what extent this technology will change our world.
Businesses that extract maximum value from ChatGPT will use it as a collaborative tool for everything from brainstorming to technical maintenance.
For individuals, now is the time to pinpoint the skills the future professional will need to thrive in the AI age.
Check out this presentation to understand what ChatGPT is, how it will shape the future of work, and how you can prepare to take advantage.
A brief introduction to DataScience with explaining of the concepts, algorithms, machine learning, supervised and unsupervised learning, clustering, statistics, data preprocessing, real-world applications etc.
It's part of a Data Science Corner Campaign where I will be discussing the fundamentals of DataScience, AIML, Statistics etc.
Time Management & Productivity - Best PracticesVit Horky
Here's my presentation on by proven best practices how to manage your work time effectively and how to improve your productivity. It includes practical tips and how to use tools such as Slack, Google Apps, Hubspot, Google Calendar, Gmail and others.
The six step guide to practical project managementMindGenius
The six step guide to practical project management
If you think managing projects is too difficult, think again.
We’ve stripped back project management processes to the
basics – to make it quicker and easier, without sacrificing
the vital ingredients for success.
“If you’re looking for some real-world guidance, then The Six Step Guide to Practical Project Management will help.”
Dr Andrew Makar, Tactical Project Management
Unlocking the Power of ChatGPT and AI in Testing - A Real-World Look, present...Applitools
During this webinar, Anand Bagmar demonstrates how AI tools such as ChatGPT can be applied to various stages of the software development life cycle (SDLC) using an eCommerce application case study. Find the on-demand recording and more info at https://applitools.info/b59
Key takeaways:
• Learn how to use ChatGPT to add AI power to your testing and test automation
• Understand the limitations of the technology and where human expertise is crucial
• Gain insight into different AI-based tools
• Adopt AI-based tools to stay relevant and optimize work for developers and testers
* ChatGPT and OpenAI belong to OpenAI, L.L.C.
Unlocking the Power of ChatGPT and AI in Testing - A Real-World Look, present...
ULCUS CRURIS ms 4aa.ppt
1. ETIOLOGIJA I KLASIFIKACIJA
Oko 90% ulceracija nastaje kao posljedica
cirkulatornih bolesti.
Mogu biti:
- venske
- venske i arterijske
- arterijske
- neuropatske
- druge
2. Financial and Cost
Patients with chronic wounds are often unemployed, marginalized, and
isolated. In a study of 21 patients with diabetic foot ulcers by Ashford,
McGee, and Kinmond,61 79% of patients reported an inability to maintain
employment secondary to decreased mobility and fear of someone
inadvertently treading on their affected foot.
In another study, all patients
interviewed felt that the leg ulcer limited their work capacity, with 50%
adding that their jobs required standing most of their shift.62 In that same
study, 42% of patients identified the leg ulcer as a key factor in their
decision to stop working. Even for younger patients, leg ulceration was
correlated with time lost from work and job loss, ultimately affecting
finances.62
3. Beyond occupational stressors and dilemmas, patients may incur
additional out-of-pocket expenses for transportation, parking, telephone
bills for medical follow-up, home health aide services, dressing supplies
not covered by insurance, and drug costs if they have no prescription plan.
Those who have no insurance but don’t qualify for public assistance may be
forced to tap into their savings or refinance their homes. Healthcare
professionals, rather than simply dismissing patients as nonadherent, should
show empathy, acknowledging access and financial hardships faced by
patients, and partner with their patients in addressing these issues.63,64
Social Relationships and Role Function
Feeling embarrassed about the repugnant smell and fluid leakage from
wounds and their bodies, people with chronic wounds may intentionally
avoid social contacts and activities. Patients often feel detached and
emotionally distant from their friends and families, rendering it difficult to
maintain meaningful friendship and romantic relationships. Patients with
38
4. Provision of wound care requires a systematized and holistic approach to
address comorbid conditions and psychosocial issues, expertise that extends
41
beyond local wound care and dressing selection. A well-coordinated and
interprofessional team approach is integral to the delivery of
highperformance
and evidence-based wound care services. Management of
these ulcers involves a detailed examination and discussion with patients to
adequately address their concerns. Although traditional educational
interventions to improve knowledge are necessary, they are rarely sufficient
to change behaviors. Emerging evidence highlights a need to shift the
chronic disease management paradigm to focus on patient engagement and
self-management (Fig. 1-2).
Figure
5.
6. CEAP klasifikacija
0. - potpuno zdrave noge
1. - noge s proširenim "kapilarama" tj. teleangiektazijama ili sa
crvenilom oko gležnja
2. - noge se vrećasto proširenim venama, tj. varikoznim
venama, koje su vrlo često i bolne, ponekad sklone krvarenju
3. - natečene noge uslijed popuštanja vena proširenih vena
4. - kronično otvrdnuće kože na kronično otečenim nogama -
lipodermatoskleroza
5. - noge s zaliječnenim ulkusom (ranom)
6. - noge s otvorenom ranom (ulkusom, njem. offenes Bein)
7. EPIDEMIOLOGIJA
- Prevalencija ulceracija donjih ekstremiteta u
odrasloj populaciji je 0,2 do 2%.
- Iako se češće javlja kod starijih osoba, početak
ulceracija krajem četvrte desetljeća života
registriran je u oko 22% slučajeva.
- Oboljenje značajno utiče na radnu sposobnost,
životne navike i zahtijeva visoke troškove
liječenja.
8. Kronična rana znatno umanjuje kvalitetu života
bolesnika, zahtijeva kontinuiranu lokalnu terapiju,
uzrokuje imobilnost bolesnika i u visokom je postotku
praćena bolovima.
Potkoljenični ulkus javlja se u 0,6–3 % osoba starijih od
60 godina, a u dobnoj skupini iznad 80 godina taj je
broj veći od 5 %.
Kronične rane su rastući socioekonomski problem u
razvijenim zemljama i javljaju se u 1-2 % populacije.
Procjenjuje se da će taj broj rasti s obzirom na starenje
populacije te porast incidencije dijabetesa i pretilost.
9. Troškovi liječenja se izračunavaju tako da se zbroje izravni (neposredni) i
indirektni (posredni) troškovi.
Izravni su troškovi: zavojni materijal kojim previjamo ranu, sredstva za
čišćenje rane – dezinficijensi, kirurške ili radiološke intervencije, liječenje
komplikacija, liječenje osnovne bolesti, lijekovi (analgetici, antibiotici), vrijeme
provedeno u bolnici - cijena hospitalizacije, vrijeme potrebno za njegu
pacijenta (vrijeme medicinske sestre, vrijeme liječnika), putovanje pacijenta
liječniku ili obratno (putni troškovi), zbrinjavanje otpadnog materijala nakon
obrade rane.
Indirektni troškovi su: kvaliteta života bolesnika, utjecaj na standard obitelji,
potreba za ispomoći bolesniku pri obavljanju osnovnih životnih aktivnosti,
duljina izostanka s posla.
Huljev i suradnici su došli do troška liječenja ulkusa od 25 000 kuna godišnje.
10. Kronična rana dokazano je izvor velikih troškova u
zdravstvu, čak i za bogata društva. Epidemiološki
podatci i troškovi liječenja kroničnih rana u razvijenim
su zemljama dobro dokumentirani.
Na zbrinjavanje kroničnih rana u razvijenim zemljama
troši se i do 2% proračuna za zdravstvo.
Sjedinjene Američke Države (SAD) 6,5 milijuna
oboljelih od kroničnih rana
Za liječenje troši se 25 milijardi dolara godišnje.
11. U SAD-u prevalencija dekubitusa u jedinicama intenzivne njege
iznosi 22 %
Trošak 11 milijardi dolara godišnje.
Prevalencija dekubitusa u Europi među hospitaliziranim
bolesnicima iznosi više od 20 %.
Zbrinjavanje dijabetičkog stopala s ulceracijom u SAD-u tijekom
2001. godine potrošeno je 9 milijardi dolara.
U specijaliziranim centrima u Njemačkoj trošak liječenja venskog
ulkusa iznosi 11.000 eura po bolesniku .
Troškovi liječenja kroničnih rana su značajni odnosu na neke
druge bolesti i da nije nevažno na koji način i kojim materijalima
će se rane tretirati.
12. Procjena za Karlovačku županiju (bolnice,
domovi zdravlja i opća medicina , ustanove za
njegu domovi umirovljenika, udomiteljstva) je
oko 600 bolesnika sa ulkusima i dekubitusima
godišnje što se objašanjava sa vrlo starom
populacijom i velikom koncetracijom ustanova
za udomiteljstvo.
Prosječan trošak zbrinjavanja na našem području
je oko 15 000 000 kuna.
13. U tri hrvatske županije već je sada udio starijih
(65+) prešao brojku od 20% (Ličko-senjskoj,
Karlovačkoj i Šibensko-kninskoj županiji), a
tekuća dobna struktura u tim županijama nije
povoljna i za očekivati je nastavak još bržeg
procesa demografskog starenja.
14.
15. PRETRAGE
Laboratorijske analize
- SE, KKS, DKS, glikemija, kolesterol
otkrivaju eventualne hematološke
poremećaje, šećernu
bolest, vaskulitis
fe uibc tibc protinogram, konzultacija
nutricioniste
- bris ulceracije kod kliničkih znakova
infekcije, celulitisa i drugih
komplikacija
- epikutani (patch) test na komponente
baza i konzervansa, antibiotike,
sastojke zavoja kod
nastanka kontaktnog alergijskog
dermatitisa
- biopsija ruba ulceracije (ukoliko nema
tendencije zarastanja ni poslije tri
mjeseca
odgovarajuće intenzivne terapije) radi
isključivanja maligne alteracije ili
vaskulitisa
- procjena vaskularnog statusa
(Doppler sonografija, kapilaroskopija,
digitalna pletizmografija,
određivanje ankle-brachiale index-a –
ABI).
16. LIJEČENJE
Opće mjere
- liječenje udruženih bolesti: edema, hipertenzije,
dijabetesa, anemije i dr.
- minimiziranje ili uklanjanje faktora rizika,
promjena navika,
- favoriziranje svakodnevnog kretanja ili
vježbanja
17. Kompresivna terapija
• kompresivna terapija je
"kamen temeljac terapije"
venskih ulceracija
(kompresivni zavoj,
medicinske čarape sa
graduisanim pritiskom,
Unna kompresivna
"čizma", neelastična
bandaža).
- graduirana kompresivna
terapija podrazumijeva 40
mmHg oko prsta do 17
mmHg do ispod
koljena.
18. pravilno postavljen
elastični zavoj
mora biti postavljen od
prsta do ispod koljena,
uz prethodno eleviranu
nogu ili u krevetu prije
ustajanja
19. Kontraindikacije za kompresivnu terapiju:
- poremećaj arterijske
cirkulacije,
- inficirane rane sa jakim
lučenjem sa akutnom
upalom kože i potkožnog
tkiva,
- metabolički edem,
- dekompenzacija srca
20. Lokalna terapija
- mora biti prilagođena
fazi zarastanja rane
Oblozi fiziološke otopine
- za kupke se koriste
blagi rastvori KMnO4,
hlorheksidina ili povidin
joda
- preporučuju se za
ulceracije u svim fazama
Mehaničko čišćenje
- čišćenje je neophodno
u svim fazama ulceracije
- pri čišćenju bolnih
ulceracija može se
primijeniti superficijalna
anestezija sa lidokain
gazom ili mašću
21. Oblozi (održavaju vlažnost rane)
- najčešće se koriste oblozi NaCl, više puta dnevno, 15 do 30
minuta
- mogu poslužiti i za debridman nekrotičnih ulceracija ukoliko
gaza natopljena NaCl ostane na rani dok se ne osuši, te
skidanjem gaze se skinu i nekrotične naslage
- kod ulceracija inficiranih Gram negativnim bakterijama
(Pseudomonas) preporučuju se oblozi 0,5 do 5% octene kiseline
Enzimska terapija (Fibrolan, Iruxol, Solcoseryl, granugel, purilon)
- za sekretorne nekrotične i suhe nekrotične ulceracije
22. NAJČEŠĆE GREŠKE U LIJEČENJU ULKUSA
POTKOLJENICA
Nekorektna kompresija
- Važnija je adekvatna graduirana kompresivna terapija nego vrsta kompresije!
- adekvatna medicinska kompesivna čarapa sa graduiranim pritiskom
prilagođava se individualno (najbolje su medicinske elastične čarape koje se
prema ABI i izmjerenom obimu noge dobiju na recept)
Primjena lokalnih antibiotskih masti
- neopravdano se široko primjenjuju u terapiji venskih ulceracija
- infekcija venskih ulceracija je rijetka, brisom se obično izolira normalna
kožna flora
- infekcija je češća kod arterijskih i neuropatskih ulceracija
- često izazivaju kontaktnu senzibilizaciju i rezistenciju
24. Praktični problemi u liječenju ulkusa
Nepostojanje kontinuirane edukacije
- neophodna je kontinuirana edukacija liječnika,
medicinskih sestara i pacijenata
- omogućuje izbor suvremene terapije, ubrzava
vijeme zarastanja, smanjuje stopu recidiva,
troškove liječenja i gubitak radnih dana.