PURPOSE: Burnout is defined as a three-dimensional syndrome—emotional exhaustion (EE), depersonalization (DP), and reduced personal accomplishment (PA)—caused by chronic occupational stress. The aim of the current study was to investigate the prevalence of burnout among oncologists in Eastern Europe and to identify the contributing factors. METHODS: The study was conducted as an online survey between October 2017 and March 2018. Oncologists (including medical, radiation, clinical, and surgical oncologists) from 19 countries were invited to participate. The survey consisted of 30 questions, including the standardized burnout instrument, Maslach Burnout Inventory, and eight demographic questions. Burnout risk was scored according to the scoring manual for health care workers. RESULTS: The study included 637 oncologists. Overall, 28% were at low or intermediate risk and 72% were at high risk for burnout. Forty-four percent of participants were at high risk for EE, 28.7% for DP, and 47.3% for PA. EE risk was associated with female sex. DP risk was highest among clinical and radiation oncologists, whereas PA risk was positively correlated with years of service, percentage of cancer deaths, and availability of the number of oncologists. In multivariate logistic regression analysis, burnout was significantly associated with standardized cancer mortality and fewer years of practice. CONCLUSION: Burnout among oncologists in Eastern Europe is high, and younger oncologists are the most vulnerable group. Preventive measures should be taken to address this issue, which negatively affects optimal care delivery and poses a threat to oncologists’ health and well-being.

SummaryAim. In ankylosing spondylitis (AS) inflammatory activity probably plays a key role in the pathophysiology of bone loss. The aim of the study was to investigate the relationship of bone mineral density (BMD) at the lumbar spine and hip region with some measures of disease activity and functional ability in patients with ankylosing spondylitis.Methods: In 80 patients with established ankylosing spondylitis disease activity and functional ability were determined by C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Bath Ankylosing Spondylitis Functional Index (BASFI). Spinal pain and patient global health were assessed using horizontal visual analogue scale (VAS). BMD was measured by dual-energy x-ray absorptiometry (DXA).Results. There was a significant negative correlation of bone density T scores with acute phase reactants (i.e. patients with lower T scores had higher level of CRP and ESR). That relationship was reflected more reliably at proximal femur sites than at the lumbar spine.There were also significant differences in ESR, BASDAI, BASFI, spinal pain and global health between three groups of patients according to WHO classification of osteoporosis (normal, osteopenic and osteoporotic). Significantly more patients with osteopenia at the lumbar spine had lower BASDAI index than those with normal BMD (p=0.030). Conclusion:Our results indicate an association of low BMD with high disease activity in patients with AS. Femoral BMD seems to be more associated with disease activity and functional ability than lumbar spine BMD.

The objective of this study was to evaluate the impact of comprehensive medication management (CMM) services on healthcare utilisation and cardiovascular risk factors among older patients with established cardiovascular diseases (CVDs). This quasi-experimental study that was performed at the Croatian primary care ambulatory clinic included patients aged 65 to 80 years. Patients were divided into intervention (65 patients) and control groups (68 patients) and were followed-up for one year. Pharmacists provided face-to-face consultations to patients from the intervention group. Groups were compared with regards to the clinical parameters (blood pressure, HbA1c, LDL, TC) and healthcare utilisation (hospital admission, emergency visits, unplanned GP visits). The CMM intervention significantly improved systolic blood pressure (p = 0.038), diastolic blood pressure (p = 0.001), total cholesterol (p = 0.014), low-density lipoprotein cholesterol (p = 0.005), and glycosylated haemoglobin (p = 0.045) in comparison with the control group. Patients included in CMM services had statistically and clinically lower systolic (−9.02 mmHg, p < 0.001) and diastolic blood pressure (−4.99 mmHg, p < 0.001) at the end of the study. The number of hospital admissions and unplanned GPs visits were 3.35 (95% CI 1.16–10.00) and 2.34 (95% CI 1.52–3.57) times higher in the control group compared to the intervention group, respectively. This study demonstrated that pharmacists providing CMM services can significantly contribute to better clinical outcomes and lower healthcare utilisation, thus potentially contributing to total healthcare savings.

This study employed a mixed-method approach to enable the implementation of comprehensive medication management (CMM) services in Croatia’s primary care setting. Drug therapy problems (DTPs) and factors associated with their occurrence were determined in patients with chronic diseases from January 2018 to April 2019. The pre-implementation stage established the foundations for the early implementation stage, in which the practice was set up, the patients’ recruitment initiated and various challenges identified. During the study period, 86 patients were recruited for CMM provision. Overall, 2.8 DTPs (± 1.6) per patient were identified and the majority (96.2 %) presented with at least one DTP. Multiple regression analysis showed that type 2 diabetic patients (p = 0.025) and patients using five or more medications (p = 0.011) should be prioritized to receive CMM services as potentially they have a higher number of DTPs, and could, therefore, obtain a greater benefit from the service.

(2006) The role of preoperative lymphoscintigraphy in surgery planning for sentinel lymph node biopsy in malignant melanoma. Wiener klinische Wochenschrift, was performed four to six hours prior to operation of the patient. Sentinel lymph node biopsy using intraoperative hand-held gamma probe was performed in all patients, as well as wide local excision of biopsy wound or primary lesion (N=56). Immediate complete basin dissection was performed in patients with sentinel node metastases. In four patients delayed complete lymph node dissection was performed due to definitive histopathologic examination of sentinel node. The accuracy of sentinel node biopsy was determined by comparing the intraoperative rates of sentinel node identification and the subsequent development of nodal metastases in regional nodal basins of patients with tumor negative sentinel node and in those with tumor positive sentinel node.Results. By preoperative lymphoscintigraphy we identify sentinel node in all but one patient (99.0%). In 248 nodal basins (1.2/patient) 372 sentinel nodes (1.52 sentinel/basin; 1.8 sentinel/patient) were observed. The highest number of sentinel nodes was noticed in the groin of patients with melanoma on lower extremities (1.5/patient), followed by axilla with 1.3 per patient. Anomalous lymphatic drainage patterns were observed in 15.0% of all patients. Sentinel node identification rate was 99.0% overall; 100% for the groin basins, and 98.0% for the axilla and head and neck basin. Forty-two patients (20.8%) had tumor positive sentinel nodes. Local or distant recurrences had 10 (5.0%) patients during median follow up of 23.1 months (range 2-46 months). The rate of false-negative lymphatic mapping and 3 sentinel node biopsy as measured by nodal recurrence in a tumor-negative SN patients was 1.3%. During the follow-up period three of 201 patients died due to the other diseases and three patients died due to the melanoma metastases, with median follow up of 13.5 months (range 12 to 22). Conclusion.Preoperative lymphoscintigraphy is sensitive, inexpensive and essential method for the identification of drainage basins, determination of number and position of sentinel node and its location outside the usual nodal basins. Scintigraphic findings may lead to changes in surgical management due to the unpredictability of lymphatic drainage. Low incidence of regional disease recurrence in patients with tumor negative sentinel node supports the use of preoperative lymphoscintigraphy and sentinel node biopsy as a safe and accurate procedure for staging the regional nodal basin in patients with malignant melanoma.