Why Croatian patients increasingly opt for treatment in private medical clinics?

The professional conduct of medical professionals should be a guarantee to the citizens of Croatia that, if they become patients, their medical institutions, regardless of whether they are private or state-owned, will provide them with a good-quality and timely medical care. Efficient organization of medical care depends on the entire medical community, and patient's satisfaction is a result of its members' interaction. Unacceptably long waiting lists, preoccupied primary care doctors, insufficient quantities of drugs and financial resources make the functioning of public medical institutions difficult. The objective of this article is to assess the reasons why patients opt for treatments in privately owned medical centers. The survey has been conducted in February 2008 on 200 patients of one privately owned health institution in Zagreb. The questionnaire consisting of 13 questions, compared different aspects of treatment in private and public health care institutions. Answers pointed out that three most frequent difficulties the patients meet while being treated in public institutions are long waiting lists for examination or surgery, too long waiting times in outpatient clinics, and indifference of the medical staff. The average grade of satisfaction with treatment is 4.57 in public institutions and 8.89 in private institutions (Tab. 8, Ref. 14).

Predictive value of assessment of disc-radicular conflict of the cervical segment by somatosensory evoked potentials.

Somatosensory evoked potentials (SSEP) of the n. medianus, with clinically significant neurological findings helps in diagnosing a number of different cervical spine lesions. SSEP of the n. medianus and neurological observations also aid in diagnosticis of the disc-radicular conflict. A final diagnosis is set by the computerised tomography (CT). The tested positive predictive value of assessment of disc-radicular conflict of the cervical spine by means of SSEP is 87%. The 95% confidence interval (CI) is 0.87 (0.81-0.93) (Tab. 3, Fig. 4, Ref. 23). Full Text (Free, PDF) www.bmj.sk.

Alzheimer's disease patients: quality of life in the Republic of Croatia.

The most common among dementias is Alzheimer's disease (AD). At the beginning it is controllable by medications but, as the disease advances, the patient needs a 24-hour care and very often one family member has to devote him/herself to the permanent care of the ill. AD dictates both patient's and family member's lives. The illness demands routine, patient behaviour, adjustments in living conditions as well as a lot of sacrifice. Although AD patients need adequate care in medical and social institutions, the caregiver's role is crucial. Therefore, the care for AD patients implicates the care for family members, i.e. caregivers. Such care should consist of medical care to caregivers, joint planning of the progress of illness and full daily patient care as well as legal advice. Croatia still hasn't got a fully developed care system for neither of the participants in the Alzheimer's disease (Ref. 22). Full Text (Free, PDF) www.bmj.sk.

Lamotrigine in the treatment of pain syndromes and neuropathic pain.

Anti-epileptic drugs are increasingly used in the treatment of pain syndromes and neuropathic pain. Sodium channel blockers can be effective in the treatment of pain. The object of our interest is the efficiency of lamotrigine in treating the pain. A MEDLINE search was conducted to identify pertinent studies, case reports, letters, and reviews in English published from 1986 to May 2007. The search has indicated efficiency in treating a number of painful syndromes and neuropathic pain; central pain, trigeminal neuralgia and trigeminal neuralgia in multiple sclerosis, pain in multiple sclerosis, SUNCT syndrome, cluster headache, glossopharyngeal neuralgia, neuropathic pain, allodynia, neuralgia after nerve section, postherpetic neuralgia, HIV-associated neuropathy. Further researches are required on the role of lamotrigine in treating the spinal cord injury pain, neuralgia after nerve section, postoperative analgesic requirement, and in migraine (Tab. 1, Ref. 46). Full Text (Free, PDF) www.bmj.sk.

Spondylodiscitis.

Spondylodiscitis is the most common complication of sepsis or local infection, usually of an abscess. Very often it develops in patients immunocompromised by a malignant disease, infection, or during immunosupression for organ transplantations etc. Presently, the basic diagnostic examinations to establish spondylodiscitis are the magnetic resonance (MRI) and biopsy, with microbiological tests. Lately, infection causes are increasingly proven by PCR method. In this paper we describe the causes of spondylodiscitis by reviewing the existing literature. The main causative organisms are staphylococci and Mycobacterium tuberculosis. The causes of spondylodiscitis are assigned to a large number of bacteria, fungi, zoonoses, which is to be taken into consideration in diagnostic treatment of patients (Ref. 51). Full Text (Free, PDF) www.bmj.sk.

An acute headache and hydrocephalus caused by the dermoid cyst.

We present a case report of a 41-year-old man with an acute headache and hydrocephalus caused by the dermoid cyst. The dermoid cyst of the third brain ventricle caused an acute hydrocephalus and an increased intracranial pressure (with neurological signs such as nausea, vomiting, oedema papilae n. optici) and, consequently, an acute intensive headache. Computed tomography scans demonstrated a mass in the third ventricle extending into the prepontine cistern, whereas any initially established cerebrospinal fluid ventriculoperitoneal shunt required further revision (Fig. 2, Ref. 12). Full Text (Free, PDF) www.bmj.sk.