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dc.contributor.advisorJanković, Slobodan
dc.contributor.otherJakovljević, Mihajlo
dc.contributor.otherMilovanović, Jasmina
dc.contributor.otherMikov, Momir
dc.creatorIlić, Darko M.
dc.date.accessioned2016-06-05T15:49:01Z
dc.date.available2016-06-05T15:49:01Z
dc.date.available2020-07-03T15:18:39Z
dc.date.issued2016
dc.identifier.urihttp://eteze.kg.ac.rs/application/showtheses?thesesId=2909
dc.identifier.urihttp://nardus.mpn.gov.rs/handle/123456789/5441
dc.identifier.urihttps://fedorakg.kg.ac.rs/fedora/get/o:658/bdef:Content/download
dc.description.abstractUvod: Rana dijagnoza osteoporoze i pravovremeni početak terapije bolesti su od velikog i suštinskog značaja za svakog pacijenta, naročito kod svih obolelih koji imaju jedan ili više faktora koji su okarakterisani kao rizični za obolevanje od ove bolesti. I pored toga što su smernice za dijagnostikovanje, terapiju i uopšte lečenje osteoporoze dostupne u mnogim zemljama sveta, njihova primena je opšte i generalno gledano i dalje loša, uprkos sve većoj dostupnosti tretmana sa dokazanom i efikasnom delotvornošđu. Cilj: Glavni ciljevi rada su utvrditi postojeće stanje u lečenju osteoporoze u najvećim centrima za lečenje ove bolesti koji se nalaze teritoriji grada Beograda, utvrditi uzroke loše adherence i administrativno – finansijskih prepreka u lečenju osteoporoze i predložiti mere za otklanjanje utvrđenih prepreka u lečenju osteoporoze. Metod: I. Metod istraživanja je predstavljao analizu anonimnih anketnih upitnika koje su pacijenti popunjavali na dobrovoljnoj bazi. Pacijentima obolelim od osteoporoze su podeljeni Anketni upitnici sa pitanjima podeljenim u pet grupa. II. Metod istraživanja je bio razgovor sa pacijentima, relevantnim zdravstvenim radnicima (reumatolozima, fizijatrima, ortopedima) i predstavnicima Republičkog fonda za zdravstveno osiguranje (RFZO) (direktorom, članovima upravnog odbora, članovima komisija RFZO – centralna stručna komisija za lekove) o njihovim subjektivnim stavovima kada su u pitanju pojedini lekovi koji se koriste u terapiji ove bolesti. III. Metod istraživanja je obuhvatio analizu foruma na internet stranicama (doktor.rs/forum, serbianforum, forum.krstarica, forum.b92, ana.rs/forum, kao i mnogih drugih stranih foruma na engleskom jeziku) gde su pacijenti ili njihovi najbliži rođaci od lekara ili drugih osoba obolelih od osteoporoze tražili savete za svoje ili tegobe njihovih ukućana, odnosno davali mišljenje o dejstvu nekog leka na ovu bolest. Rezultati: Najčešči jasno definisani razlozi koje su pacijenti u našoj studiji navodili kao prepreke zbog kojih ne poštuju i ne uzimaju propisanu terapiju za lečenje osteoporoze su: a) da se oni trenutno objektivno ne osećaju bolesno. Ovakav direktan odgovor pacijenta lekaru proističe iz poznate asimptomatske zamagljene prirode osteoporoze, što predstavlja poseban, ali veoma značajan problem za optimalan tretman i poštovanje propisane tepapije. b) olako shvatanje da osteoporoza nije i baš tako ozbiljna bolest zbog koje se treba zavrinjavati. Pored pitanja koja proističu asimptomackom i neprepoznatljivom prirodom osteoporoze kao hronične bolesti, naše istraživanje je pokazalo, da mnogi pacijenti naročito i ne cene povećan rizik od potencijalnih preloma, koji mogu nastati kao uzrok i posledica osteoporoze. c) Zabrinutost zbog potencijalnih neželjenih efekata lečenja koje prouzrokuju farmakološki medikamenti. Prema našoj studiji nastajanje preloma kod osteoporoze je u statistički značajnoj vezi sa zanimanjem pacijenata. hi2 = 22,830 df = 4 p < 0,001. Ispitanici koji žive na selu imaju značajno više preloma prouzrokovanih osteoporozom, od ostalih kategorija stanovnika. ( hi2 = 18, 914) df = 2 p < 0,001. Pacijenti koji su se bavili spornom su imali statistički značajno manje preloma. hi2 = 6,688 df = 1 p<0,01. Prema hi – kvadrat testu javlja se statistički značajna razlika u odnosu na upotrebu namirnica koje su bogate kalcijumom i vitaminom D i postojanja preloma obolelih od ostoporoze. hi2 = 4,251 df = 1 p < 0,05 Zaključak: Kako bi se izbegli neočekivani bez prisustva objektivne traume izazvani prelomi kostiju i neželjene posledice osteoporoze, ovu bolest je potrebno dijagnostikovati i lečiti na vreme, i to u najranijim stadijumima njenog razvitka. Rana dobro utvrđena dijagnoza osteoporoze i pravovremeni početak farmakološke terapije ove bolesti su od velikog i suštinskog značaja za svakog pacijenta, naročito kod svih obolelih koji imaju jedan ili više faktora okarakterisanih kao rizičnih za obolevanje od ove hronične bolesti. I pored toga što su savremene naučno zasnovane smernice za dijagnostikovanje, terapiju i uopšte lečenje osteoporoze dostupne u mnogim zemljama sveta, njihova primena je opšte i generalno gledano i dalje loša, uprkos sve većem postojanju raznovrsnih tretmana sa utvrđenom i efikasnom delotvornošću.sr
dc.description.abstractIntroduction: Early diagnosis of osteoporosis and timely initiation of treatment of diseases of great and essential for every patient, especially in all patients who have one or more factors that are characterized as risk of developing this disease. Despite the fact that the guidelines for the diagnosis, treatment and general treatment of osteoporosis are available in many countries, their use is common and generally still poor, despite the increasing availability of treatment with proven and effective delotvornošđu. Objective: The main objectives of the paper were to establish the current situation in the treatment of osteoporosis in the largest centers for the treatment of these diseases that are the city of Belgrade, to determine the causes of poor adherence and administrative - financial obstacles in the treatment of osteoporosis and propose measures to eliminate the obstacles in the treatment of osteoporosis. Method: I. The research method was an analysis of anonymous questionnaires completed by patients on a voluntary basis. Patients suffering from osteoporosis are divided Questionnaires with questions divided into five groups. II. The research method was to discuss with patients, relevant healthcare professionals (rheumatologists, physiatrists, orthopedists) and representatives of the Health Insurance Fund (NHIF) (director, board members, committee members NHIF - the central expert committee for medicine) on their subjective views when in terms of individual drugs used in the treatment of this disease. III. The research method included an analysis of the forum on the website (doktor.rs/forum, serbianforum, forum.krstarica, forum.b92, ana.rs/forum, as well as many other international forums in English) where patients or their close relatives from physician or other person suffering from osteoporosis sought advice for their problems or their family, or give an opinion on the effects of a drug in this disease. Results: The most common and clearly defined reasons given by patients in our study cited as obstacles for not respected and not taking prescribed medication for the treatment of osteoporosis are: a) that they realistically do not feel sick. Such a direct response of the patient to the doctor derives from the famous asymptomatic blurred nature of osteoporosis, which is a special, but very important problem for optimal treatment and respect prescribed tepapije. b) lightly perception that osteoporosis is not only and not so serious disease that needs to be zavrinjavati. In addition to issues arising asimptomackom and unrecognizable nature of osteoporosis as a chronic disease, our study has shown that many patients and especially do not appreciate the potential increased risk of fracture, which can occur as a cause and a consequence of osteoporosis. c) Concern over potential side effects of treatment caused by pharmacological drugs. According to our study the formation of fractures in osteoporosis is statistically significantly correlated with interest of patients. hi2 = 22,830 df = 4, p <0.001. Respondents living in the country have significantly more fractures caused by osteoporosis than other categories of citizens. (Hi2 = 18, 914) df = 2, p <0.001. Patients who have dealt with the controversial had significantly fewer fractures. hi2 = 6,688 df = 1, p <0.01. According to Chi - square test, there is a statistically significant difference in relation to the use of foods that are rich in calcium and vitamin D and the existence of fractures in patients with osteoporosis. hi2 = 4,251 df = 1, p <0.05 Conclusion: In order to avoid unexpected absence of objective trauma induced fractures and adverse effects of osteoporosis, the disease is necessary to diagnose and treat in time, in the earliest stages of its development. Early well-established diagnosis of osteoporosis and timely onset of pharmacological therapy of these diseases are of great and essential for every patient, especially in all patients who have one or more factors characterized as high-risk of developing this chronic disease. Despite the fact that the modern science-based guidelines for the diagnosis, treatment and general treatment of osteoporosis are available in many countries, their use is common and generally still poor, despite the increasing presence of various treatments with established and effective effectiveness.en
dc.formatapplication/pdf
dc.languagesr
dc.publisherУниверзитет у Крагујевцу, Факултет медицинских наукаsr
dc.rightsopenAccessen
dc.sourceУниверзитет у Крагујевцуsr
dc.subjectosteoporozasr
dc.subjectfarmakoterapijasr
dc.titleAnaliza lečenja osteoporoze u kliničkoj praksi metodom proučavanja sa tri različita aspektasr
dc.typedoctoralThesis
dc.rights.licenseBY-NC-ND
dcterms.abstractЈанковић, Слободан; Миловановић, Јасмина; Јаковљевић, Михајло; Миков, Момир; Илић, Дарко М.; Aнализа лечења остеопорозе у клиничкој пракси методом проучавања са три различита аспекта; Aнализа лечења остеопорозе у клиничкој пракси методом проучавања са три различита аспекта;
dc.identifier.fulltexthttp://nardus.mpn.gov.rs/bitstream/id/49656/Disertacija2726.pdf
dc.identifier.fulltexthttp://nardus.mpn.gov.rs/bitstream/id/49657/Izvestaj Darko Ilic medicina.pdf


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