Fizičko vežbanje kao mehanizam upravljanja stresom
Način reagovanja na potencijalno stresne situacije je individualan i zavisi od dva osnovna faktora. Prvi je način na koji osoba percipira i interpretira situaciju, a drugi faktor se odnosi na stanje samog tela, odnosno organizma. Usled hroničnog stresa, sindroma izgaranja i posttraumatskog stresnog poremećaja često dolazi do nastanka bolesti. Stres može uticati na zdravlje direktno, putem autonomnih i endokrinih reakcija koje izaziva, ali i indirektno, putem promene u zdravstvenom ponašanju koje mogu nastati posle stresa. Fizičko vežbanje se često preporučuje kao deo programa upravljanja stresom. Dokazano je da se vežbanjem smanjuju hormoni stresa i reaktivnost na stres. Vežbe prilagođene stepenu fizičkih mogućnosti i nivou motivacije osobe, smatraju se odličnim početnim pristupom u upravljanju psihičkim stresom. Fizička aktivnost nije važna samo kao primarna prevencija mnogih hroničnih bolesti, već i kao sekundarna prevencija koja usporava i smanjuje simptome hroničnih bolesti. Osim uticaja na hronične bolesti, fizička aktivnost snažno utiče i na poboljšanje samopouzdanja, društvenih veština, kognitivnog funkcionisanja, smanjuje simptome stresa, što zajedno sa ostalim pozitivnim efektima doprinosi boljem kvalitetu života. Rezultati postojećih istraživanja pokazuju da fizičko vežbanje može da utiče na kognitivno funkcionisanje tokom čitavog životnog veka, direktno, kroz fiziološke mehanizme i strukturne promene u mozgu, a indirektno kroz uticaj na raspoloženje i smanjenje stresa. Fizičko vežbanje, kroz različite mehanizme, ima snažan uticaj na ispoljavanje nivoa stresa.
Sva prava zadržana (c) 2026 Medicinski glasnik
PRIMENA TELEMEDICINE U PALIJATIVNOJ NEZI PACIJENATA SA UZNAPREDOVALIM ENDOKRINOLOŠKIM BOLESTIMA: PREDNOSTI, IZAZOVI I PREPORUKE ZA PRAKSU
Uvod: Telemedicina postaje sve značajniji deo zdravstvene zaštite, naročito u oblasti palijativne nege, gde doprinosi povećanju dostupnosti, kontinuiranosti i personalizaciji usluga. Kod pacijenata sa uznapredovalim endokrinološkim bolestima, potreba za stalnim praćenjem i podrškom čini ovu tehnologiju posebno relevantnom. Cilj: Cilj rada bio je da se identifikuju ključne prednosti i izazovi primene telemedicine u palijativnoj endokrinološkoj nezi i da se na osnovu toga formulišu preporuke za unapređenje prakse. Metodologija: Sprovedena je sistematska analiza 24 publikacije objavljene između 2015. i 2024. godine koje se bave telemedicinom u kontekstu palijativne ili endokrinološke zaštite. Analizirani su nalazi o efikasnosti, prihvatljivosti i izazovima implementacije. Rezultati: Najčešće identifikovane prednosti telemedicine uključuju poboljšan pristup zdravstvenim uslugama (83,3%), efikasnije praćenje simptoma (72,2%), povećano zadovoljstvo pacijenata (66,7%) i smanjenje potrebe za hospitalizacijom (55,6%). Među izazovima istaknuti su tehnički problemi i ograničen pristup tehnologiji (77,8%), nedovoljna edukacija osoblja (61,1%) i etičko-pravne dileme (50%). Identifikovane su i preporuke kao što su edukacija kadra, razvoj specijalizovanih platformi i unapređenje regulatornog okvira. Zaključak: Telemedicina ima značajan potencijal da poboljša kvalitet palijativne nege kod endokrinoloških pacijenata. Ipak, uspešna implementacija zahteva sveobuhvatan pristup koji uključuje tehničku infrastrukturu, obuku osoblja i podršku zdravstvenih politika.
Upotreba digitalnih alata u samopraćenju bolesti štitaste žlezde: sistematski prikaz dostupnih rešenja
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Name="List Table 7 Colorful Accent 6"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Mention"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Smart Hyperlink"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Hashtag"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Unresolved Mention"/> </w:LatentStyles> </xml><![endif]--><!-- [if gte mso 10]> <![endif]--> Cilj: Sistematski prikaz dostupnih digitalnih alata za samopraćenje bolesti štitaste žlezde, s naglaskom na funkcionalnost, kvalitet i kliničku validaciju. Metode: Sproveden je sistematski pregled literature u skladu sa PRISMA smernicama, korišćenjem baza podataka PubMed, Scopus, Web of Science i IEEE Xplore za period 2010–2025. U analizu su uključene mobilne aplikacije, veb-platforme i nosivi uređaji namenjeni odraslim osobama. Kvalitet alata procenjivan je pomoću uMARS skale, koja ocenjuje angažovanje, funkcionalnost, estetiku i informativnost. Rezultati: Identifikovano je 18 digitalnih alata. Najzastupljenije funkcionalnosti uključuju dnevnik simptoma (78%), praćenje laboratorijskih nalaza (67%) i evidenciju terapije (56%). Prosečna uMARS ocena kretala se od 3.8 do 4.5 (od maksimalnih 5). Samo 28% alata bilo je medicinski validirano, dok je pet alata integrisano sa zdravstvenim sistemima. Najveći nedostaci odnose se na izostanak personalizovanih algoritama (22%) i nejasne politike zaštite podataka (61%). Diskusija: Alati omogućavaju praćenje u realnom vremenu, ali nedostaju standardizacija, klinička validacija i interoperabilnost. Potrebna je multidisciplinarna saradnja kliničara, programera i regulatornih tela. Zaključak: Digitalna rešenja imaju potencijal da unaprede samopraćenje bolesti štitaste žlezde, ali zahtevaju rigoroznije validacione studije, bolju zaštitu podataka i personalizovane pristupe.
Transanalna ekscizija kod ranog karcinoma rektuma: Efikasan tretman za odabrane pacijente
Uvod: Transanalna ekscizija (TAE) je rektum prezervirajuća procedura koja se primenjuje u lečenju ranog stadijuma kolorektalnog karcinoma lokalizovanog u donjoj i srednjoj trećini rektuma. Iako totalna mezorektalna ekscizija (TME) predstavlja zlatni standard za lečenje karcinoma rektuma, TAE se smatra adekvatnom alternativnom procedurom za odabrane pacijente. U slučajevima kada klinički i MRI nalazi ukazuju na malignitet, a ponavljane biopsije na benigne lezije, TAE predstavlja i dijagnostičku i terapijsku proceduru. Prikaz slučaja: Tri pacijenta su evaluirana zbog tegoba u vidu prisustva krvi i sluzi u stolici i poteškoća u defekaciji. Kliničkim pregledom verifikovane su tumorske formacije u distalnom delu rektuma, lokalizovane do 4 cm od anokutane linije. Histopatološki nalazi su potvrdili prisustvo tubuloviloznih adenoma sa visokim stepenom displazije. S obzirom na karakteristike tumora, nepravilne ivice, čvrstu konzistenciju i široku tumorsku bazu, posumnjalo se na malignitet, te je sprovedena dodatna dijagnostika. MR pregled male karlice potvrdio je sumnju na malignitet, te je odlučeno da se uradi transanalna ekscizija kod svih pacijenata. Histopatologija je potvrdila rani rektalni adenokarcinom sa čistim (R0) marginama. Pacijenti su prezentovani onkološkom konzilijumu, koji je preporučio dalje praćenje. Na redovnim onkološkim kontrolama u periodu od 18 do 30 meseci nisu verifikovani znakovi recidiva bolesti. Zaključak: Transanalna ekscizija je efikasna, rektum-prezervirajuća procedura za pacijente sa ranim karcinomom rektuma ili benignim lezijama. Prikazani slučajevi pokazuju uspeh TAE u postizanju R0 resekcije i povoljnog ishoda lečenja. Redovno praćenje je ključno za otkrivanje recidiva, a TAE ostaje adekvatna alternativa opsežnijim hirurškim zahvatima kod pravilno odabranih pacijenata.
Evaluacija tačnosti mobilnih aplikacija zasnovanih na veštačkoj inteligenciji za procenu težine traumatskih povreda putem analize fotografija – simulaciona studija
<p style="margin: 0px 0px 16px; text-align: justify; font-style: normal; font-variant-caps: normal; font-width: normal; font-size: 16px; line-height: normal; font-family: 'Times New Roman'; font-size-adjust: none; font-kerning: auto; font-variant-alternates: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-position: normal; font-variant-emoji: normal; font-feature-settings: normal; font-optical-sizing: auto; font-variation-settings: normal; -webkit-text-stroke-width: 0px; -webkit-text-stroke-color: #000000;">Uvod: Brza i tačna procena težine traumatskih povreda ključna je za efikasnu trijažu i pravovremenu terapiju u urgentnoj medicini. Mobilne aplikacije zasnovane na veštačkoj inteligenciji (AI) nude mogućnost objektivne procene težine povreda putem analize fotografija, ali njihova tačnost još uvek nije dovoljno istražena. <p style="margin: 0px 0px 16px; text-align: justify; font-style: normal; font-variant-caps: normal; font-width: normal; font-size: 16px; line-height: normal; font-family: 'Times New Roman'; font-size-adjust: none; font-kerning: auto; font-variant-alternates: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-position: normal; font-variant-emoji: normal; font-feature-settings: normal; font-optical-sizing: auto; font-variation-settings: normal; -webkit-text-stroke-width: 0px; -webkit-text-stroke-color: #000000;">Cilj rada: Evaluacija tačnosti dostupnih mobilnih aplikacija zasnovanih na AI za procenu težine traumatskih povreda u simulacionim uslovima. <p style="margin: 0px 0px 16px; text-align: justify; font-style: normal; font-variant-caps: normal; font-width: normal; font-size: 16px; line-height: normal; font-family: 'Times New Roman'; font-size-adjust: none; font-kerning: auto; font-variant-alternates: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-position: normal; font-variant-emoji: normal; font-feature-settings: normal; font-optical-sizing: auto; font-variation-settings: normal; -webkit-text-stroke-width: 0px; -webkit-text-stroke-color: #000000;">Metode: U simulacionoj studiji testirano je pet mobilnih aplikacija za procenu težine povreda (DermaScore AI, SkinVision, Tissue Analytics, WoundCheck AI i BurnCare App). Ukupno 200 simuliranih fotografija traumatskih povreda klasifikovanih po AIS lestvici (lake, umerene, teške, kritične) analizirano je pomoću svake aplikacije. Evaluirane su ukupna tačnost, senzitivnost, specifičnost i ROC analiza, kao i uticaj rezolucije fotografija na performanse aplikacija. <p style="margin: 0px 0px 16px; text-align: justify; font-style: normal; font-variant-caps: normal; font-width: normal; font-size: 16px; line-height: normal; font-family: 'Times New Roman'; font-size-adjust: none; font-kerning: auto; font-variant-alternates: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-position: normal; font-variant-emoji: normal; font-feature-settings: normal; font-optical-sizing: auto; font-variation-settings: normal; -webkit-text-stroke-width: 0px; -webkit-text-stroke-color: #000000;">Rezultati: Najvišu ukupnu tačnost imala je aplikacija DermaScore AI (89%), sa senzitivnošću od 92% i AUC vrednošću od 0,91. Najnižu tačnost pokazala je aplikacija BurnCare App (74%). Utvrđeno je da veća rezolucija fotografija (preko 12 MP) značajno povećava tačnost svih aplikacija (p=0,0014). <p style="margin: 0px 0px 16px; text-align: justify; font-style: normal; font-variant-caps: normal; font-width: normal; font-size: 16px; line-height: normal; font-family: 'Times New Roman'; font-size-adjust: none; font-kerning: auto; font-variant-alternates: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-position: normal; font-variant-emoji: normal; font-feature-settings: normal; font-optical-sizing: auto; font-variation-settings: normal; -webkit-text-stroke-width: 0px; -webkit-text-stroke-color: #000000;">Zaključak: Mobilne AI aplikacije mogu pružiti pouzdane procene težine traumatskih povreda na osnovu fotografija, ali njihove performanse značajno variraju zavisno od tehničkih i algoritamskih faktora. Potrebna su dodatna klinička istraživanja za validaciju ovih rezultata u realnim uslovima.
Digitalna patologija i bioinformatička analiza ekspresije PIT1 kod makroadenoma hipofize
APSTRAKT Uvod: Makroadenomi hipofize predstavljaju izazov u kliničkoj endokrinologiji zbog njihovog uticaja na hormonalnu ravnotežu i posledičnih kliničkih komplikacija. Tradicionalne dijagnostičke metode često su ograničene subjektivnošću, što naglašava potrebu za objektivnijim pristupom. Materijali i metode: Istraživanje je sprovedeno kao retrospektivna sekundarna analiza javno dostupnih, de-identifikovanih podataka. Digitalne histopatološke slike preuzete su iz repozitorijuma digitalne patologije, dok su RNA-seq podaci, uključujući ekspresiju gena PIT1, pribavljeni iz NCBI GEO baze. Primena konvolucionih neuronskih mreža (CNN) omogućila je segmentaciju i klasifikaciju tumorskog tkiva, a analiza diferencijalne ekspresije realizovana je pomoću DESeq2. Rezultati: Model je postigao tačnost od 92,3% u identifikaciji tumorskih oblasti, dok je bioinformatička analiza pokazala značajno povećanje ekspresije PIT1 u adenoma sa izraženijim kliničkim simptomima (log2FC = 1,8, p < 0,01). Integrisana analiza je potvrdila jaku korelaciju između morfoloških obrazaca i nivoa ekspresije PIT1, a regresiona analiza ukazala je da je ovaj gen nezavisan prediktor kliničkih ishoda. Diskusija i zaključak: Integracija digitalne patologije i bioinformatičke analize pokazala se obećavajućom za unapređenje dijagnostike i klasifikacije makroadenoma hipofize, otvarajući put ka personalizovanoj terapiji. Dalja istraživanja na heterogenijim uzorcima mogu dodatno potvrditi korisnost ovog multidisciplinarnog pristupa.
Sealed-off perforacija kolorektalnog karcinoma inicijalno interpretirana kao divertikulitis: intraabdominalni apsces kao dijagnostička i terapijska dilema
Uvod: Intraabdominalni apsces često nastaje kao komplikacija perforacije gastrointestinalnog trakta izazvane inflamatornim bolestima, traumama ili malignitetom. Iako se najčešće povezuje sa divertikulitisom, perforacija kolorektalnog karcinoma, naročito u obliku zatvorene (sealed-off) perforacije, može imati identičnu kliničku sliku, što može otežati pravovremenu dijagnozu i lečenje. Iako se najčešće vezuje za divertikulitis, malignitet kao uzrok apscesa često ostaje nedijagnostikovan u akutnoj fazi. Prikaz slučaja: Prikazujemo slučaj pacijentkinje stare 61 godinu, primljene zbog febrilnosti, bolova u donjem desnom kvadrantu abdomena i laboratorijskih znakova inflamacije. Radiološki nalaz ukazivao je na apscesnu kolekciju u desnoj ilijačnoj regiji sa sumnjom na komplikovani divertikulitis. Prisustvo dolihosigme sa dekstroponiranim sigmoidnim kolonom dodatno je otežalo dijagnostiku. Lečenje je inicijalno sprovedeno konzervativno, uz antibiotsku terapiju, sa kliničkom I radiološkom regresijom. U postakutnoj fazi, protokolarno je urađena kolonoskopija kojom je otkriven tumor sigmoidnog kolona kao i masivna divertikuloza levog kolona. Histopatološkom analizom potvrđen je adenokarcinom. Pacijentkinja je elektivno operisana kada je učinjena prednja gornja resekcija rektuma sa kolo rekto TT anastomozom (bez potrebe za izvodjenjem stome) i uključena u adjuvantni onkološki protokol. Zaključak: Sealed-off perforacija kolorektalnog karcinoma može klinički i radiološki imitirati divertikulitis sa apscesom, što može dovesti do odlaganja postavljanja dijagnoze maligniteta. Posebno u prisustvu atipične anatomije, neophodna je temeljna i kompletna dijagnostička obrada, uključujući obaveznu kolonoskopiju nakon smirivanja akutne inflamacije. Ovaj slučaj ističe značaj diferencijalne dijagnostike u inicijalnoj fazi i sprovođenja protokolarnog kolonoskopskog pregleda nakon smirivanja inflamacije, što omogućava pravovremenu dijagnozu kolorektalnog karcinoma i poboljšava ishod lečenja
Mogućnosti i ograničenja konzervativnog lečenja enterokutanih fistula tankog creva
Uvod: Enterokutane fistule (EKF) su kompleksne i potencijalno životno ugrožavajuće komplikacije, koje podrazumevaju patološku komunikaciju između gastrointestinalnog trakta i kože. Najčešće nastaju kao posledica abdominalnih hirurških intervencija, dok se ređe javljaju spontano kod pacijenata sa inflamatornim bolestima creva, malignitetima ili nakon zračne terapije. Spontano zatvaranje je moguć, ali redak ishod, koji zavisi od niza kliničkih i lokalnih faktora. Cilj ovog rada je da prikaže savremene principe, mogućnosti i ograničenja konzervativnog lečenja enterokutanih fistula tankog creva, sa fokusom na faktore koji utiču na njihovo spontano zatvaranje. Metodologija: Ovaj rad je narativni pregled literature. Pretraga je sprovedena u bazama PubMed, Scopus, Web of Science i Cochrane Library za radove objavljene u periodu 2010–2025. godine. Korišćene su ključne reči: enterocutaneous fistula, conservative management, spontaneous closure, intestinal fistula. Uključene su studije na engleskom i srpskom jeziku koje se bave konzervativnim pristupima lečenju fistula tankog creva. Analizirani su faktori koji utiču na tok i ishod lečenja. Glavni nalazi: Ključni faktori koji utiču na spontano zatvaranje EKF uključuju nisku produkciju (<200 mL/dan), odsustvo infekcije, dobar nutritivni status, jednostavnu anatomsku konfiguraciju i zatvoren abdomen. Konzervativna terapija obuhvata individualizovani nutritivni plan, kontrolu sepse i infekcije, zaštitu kože uz primenu barijernih sredstava, kao i farmakološku modulaciju gastrointestinalne sekrecije (npr. somatostatin i njegovi analozi). Terapijske metode poput negativnog pritiska i fibrinskog lepka pokazuju obećavajuće rezultate u selektovanim slučajevima. Zaključak: Detaljno razumevanje faktora koji utiču na spontano zatvaranje EKF omogućava precizniju selekciju pacijenata za konzervativno lečenje. Ovaj pristup ne samo da može dovesti do izbegavanja hirurške intervencije, već i da značajno poboljša ishod kod pacijenata koji kasnije zahtevaju operaciju. Multidisciplinarni pristup ostaje ključan za uspešno zbrinjavanje ovih pacijenata.
Faktori koji utiču na izbor lekara opšte medicine među radno aktivnom populacijom u Srbiji
Ova studija istražuje kako apsentizam, socio-demografski i profesionalni faktori utiču na izbor lekara opšte medicine u Srbiji. Cilj studije je identifikacija faktora koji utiču na izbor lekara opšte medicine među zaposlenima u Srbiji, uzimajući u obzir slučajeve apsentizma. U istraživanju su analizirani podaci iz Nacionalnog istraživanja zdravlja Srbije 2019. godine, uključujući 4.652 ispitanika uzrasta od 18 do 65 godina, koristeći deskriptivnu statistiku i binarnu logističku regresiju. Ukupno 92,4% ispitanika, najviše zaposlenih u javnom sektoru (85,2%), izabralo je lekara opšte medicine, sa većom prevalencijom kod epizoda dugotrajnog apsentizma (92,8%). Na izbor lekara opšte medicine utiču socio-demografski i zdravstveni faktori. Zaposlenost kod poslodavca povećava šansu za izbor lekara opšte medicine (OR = 2,277), dok fizički radnici (OR = 0,757) i zaposleni srednjeg i siromašnog materijalnog statusa imaju manju šansu kod ispitanika bez apsentizma (srednji OR = 0,709, siromašni OR = 0,701). Zaposleni u Vojvodini sa apsentizmom imaju manju šansu za izbor lekara opšte medicine (OR = 0,111). Poslednja poseta lekaru opšte medicine je značajan prediktor kod obe grupe. Socio-demografski, faktori posla i zdravstvenog stanja značajno utiču na izbor lekara opšte medicine među zaposlenima u Srbiji, što ukazuje na značaj pristupačne primarne zdravstvene zaštite tokom perioda apsentizma.
MODELI ORGANIZACIJE „ONE-STOP“ KLINIKA ZA BOLESTI ŠTITASTE ŽLEZDE: PREGLED PROCESA, INDIKATORA PERFORMANSI I ISHODA IZ LITERATURE
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Name="List Table 7 Colorful Accent 6"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Mention"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Smart Hyperlink"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Hashtag"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Unresolved Mention"/> </w:LatentStyles> </xml><![endif]--><!-- [if gte mso 10]> <![endif]--> Pozadina: Fragmentisani putevi zbrinjavanja nodularne bolesti štitaste žlezde produžavaju vreme do odluke i povećavaju troškove. „One-stop“ klinike (OSK) integrišu klinički pregled, ultrazvuk, UZ-vođenu FNA i, po potrebi, ROSE/telecitologiju u jednoj poseti. Cilj: Mapirati organizacione modele OSK, definisati ključne pokazatelje performansi (KPI) i sumirati ishode (vreme, posete, adekvatnost, ponovljene FNA, troškovi, zadovoljstvo, bezbednost). Metode: Scoping pregled prema PRISMA-ScR i JBI. Pretražene su MEDLINE, Scopus i Web of Science (2000–avgust 2025). Uključene su studije koje operacionalizuju OSK i/ili izveštavaju KPI/ishode. Ekstrakcija je obuhvatila organizacione karakteristike, protokole (ACR/EU-TIRADS, Bethesda), metrike toka, adekvatnost FNA/ROSE, ekonomiku, zadovoljstvo i bezbednost. Sprovedena je narativna sinteza. Rezultati: Identifikovani modeli OSK dosledno skraćuju lead-time do odluke i redukuju broj poseta. Adekvatnost uzoraka je visoka, posebno uz ROSE/telecitologiju, što smanjuje ponovne punkcije. Zadovoljstvo pacijenata je visoko; bezbednosni profil FNA ostaje povoljan. Ekonomske analize ukazuju da je isplativost ROSE kontekst-zavisna i najveća pri višoj baznoj neadekvatnosti i/ili nižem trošku. Predložen je KPI paket: lead-time, udeo „jedna poseta“, Bethesda I, udeo ROSE, ponovna FNA ≤90 dana, trošak po epizodi, zadovoljstvo. Zaključak: OSK su primenljiv i vrednosno orijentisan model za dijagnostiku štitaste žlezde. Selektivna primena ROSE/telecitologije i upravljanje na osnovu KPI omogućavaju efikasnu i bezbednu implementaciju u različitim resursnim okruženjima.
PAMETNI GRADOVI I ZDRAVSTVENA INFORMATIKA: TRANSFORMACIJA URBANIH ZDRAVSTVENIH SISTEMA
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SemiHidden="true" UnhideWhenUsed="true" Name="toc 7"/> <w:LsdException Locked="false" Priority="39" SemiHidden="true" UnhideWhenUsed="true" Name="toc 8"/> <w:LsdException Locked="false" Priority="39" SemiHidden="true" UnhideWhenUsed="true" Name="toc 9"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Normal Indent"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="footnote text"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="annotation text"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="header"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="footer"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="index heading"/> <w:LsdException Locked="false" Priority="35" SemiHidden="true" UnhideWhenUsed="true" QFormat="true" Name="caption"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="table of figures"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="envelope address"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="envelope return"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="footnote reference"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="annotation reference"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="line number"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="page number"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="endnote reference"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="endnote text"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="table of authorities"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="macro"/> <w:LsdException 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UnhideWhenUsed="true" Name="Body Text First Indent 2"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Note Heading"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Body Text 2"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Body Text 3"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Body Text Indent 2"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Body Text Indent 3"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Block Text"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Hyperlink"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="FollowedHyperlink"/> <w:LsdException Locked="false" Priority="22" QFormat="true" Name="Strong"/> <w:LsdException Locked="false" Priority="20" QFormat="true" Name="Emphasis"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Document Map"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Plain Text"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="E-mail Signature"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="HTML Top of Form"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="HTML Bottom of Form"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Normal (Web)"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="HTML Acronym"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="HTML Address"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="HTML Cite"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="HTML Code"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="HTML 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SemiHidden="true" UnhideWhenUsed="true" Name="Outline List 3"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Simple 1"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Simple 2"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Simple 3"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Classic 1"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Classic 2"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Classic 3"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Classic 4"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Colorful 1"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Colorful 2"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Colorful 3"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Columns 1"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Columns 2"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Columns 3"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Columns 4"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Columns 5"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Grid 1"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Grid 2"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Grid 3"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Grid 4"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Grid 5"/> <w:LsdException 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Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Web 3"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Balloon Text"/> <w:LsdException Locked="false" Priority="39" Name="Table Grid"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Theme"/> <w:LsdException Locked="false" SemiHidden="true" Name="Placeholder Text"/> <w:LsdException Locked="false" Priority="1" QFormat="true" Name="No Spacing"/> <w:LsdException Locked="false" Priority="60" Name="Light Shading"/> <w:LsdException Locked="false" Priority="61" Name="Light List"/> <w:LsdException Locked="false" Priority="62" Name="Light Grid"/> <w:LsdException Locked="false" Priority="63" Name="Medium Shading 1"/> <w:LsdException Locked="false" Priority="64" Name="Medium Shading 2"/> <w:LsdException Locked="false" Priority="65" Name="Medium List 1"/> <w:LsdException Locked="false" Priority="66" Name="Medium List 2"/> <w:LsdException Locked="false" Priority="67" Name="Medium Grid 1"/> <w:LsdException Locked="false" Priority="68" Name="Medium Grid 2"/> <w:LsdException Locked="false" Priority="69" Name="Medium Grid 3"/> <w:LsdException Locked="false" Priority="70" Name="Dark List"/> <w:LsdException Locked="false" Priority="71" Name="Colorful Shading"/> <w:LsdException Locked="false" Priority="72" Name="Colorful List"/> <w:LsdException Locked="false" Priority="73" Name="Colorful Grid"/> <w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 1"/> <w:LsdException Locked="false" Priority="61" Name="Light List Accent 1"/> <w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 1"/> <w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 1"/> <w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 1"/> <w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 1"/> <w:LsdException Locked="false" SemiHidden="true" Name="Revision"/> <w:LsdException Locked="false" Priority="34" QFormat="true" Name="List Paragraph"/> <w:LsdException Locked="false" Priority="29" QFormat="true" Name="Quote"/> <w:LsdException Locked="false" Priority="30" QFormat="true" Name="Intense Quote"/> <w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 1"/> <w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 1"/> <w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 1"/> <w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 1"/> <w:LsdException Locked="false" Priority="70" Name="Dark List Accent 1"/> <w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 1"/> <w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 1"/> <w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 1"/> <w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 2"/> <w:LsdException Locked="false" Priority="61" Name="Light List Accent 2"/> <w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 2"/> <w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 2"/> <w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 2"/> <w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 2"/> <w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 2"/> <w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 2"/> <w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 2"/> <w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 2"/> <w:LsdException Locked="false" Priority="70" Name="Dark List Accent 2"/> <w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 2"/> <w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 2"/> <w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 2"/> <w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 3"/> <w:LsdException Locked="false" Priority="61" Name="Light List Accent 3"/> <w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 3"/> <w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 3"/> <w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 3"/> <w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 3"/> <w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 3"/> <w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 3"/> <w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 3"/> <w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 3"/> <w:LsdException Locked="false" Priority="70" Name="Dark List Accent 3"/> <w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 3"/> <w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 3"/> <w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 3"/> <w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 4"/> <w:LsdException Locked="false" Priority="61" Name="Light List Accent 4"/> <w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 4"/> <w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 4"/> <w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 4"/> <w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 4"/> <w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 4"/> <w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 4"/> <w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 4"/> <w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 4"/> <w:LsdException Locked="false" Priority="70" Name="Dark List Accent 4"/> <w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 4"/> <w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 4"/> <w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 4"/> <w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 5"/> <w:LsdException Locked="false" Priority="61" Name="Light List Accent 5"/> <w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 5"/> <w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 5"/> <w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 5"/> <w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 5"/> <w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 5"/> <w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 5"/> <w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 5"/> <w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 5"/> <w:LsdException Locked="false" Priority="70" Name="Dark List Accent 5"/> <w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 5"/> <w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 5"/> <w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 5"/> <w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 6"/> <w:LsdException Locked="false" Priority="61" Name="Light List Accent 6"/> <w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 6"/> <w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 6"/> <w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 6"/> <w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 6"/> <w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 6"/> <w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 6"/> <w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 6"/> <w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 6"/> <w:LsdException Locked="false" Priority="70" Name="Dark List Accent 6"/> <w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 6"/> <w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 6"/> <w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 6"/> <w:LsdException Locked="false" Priority="19" QFormat="true" Name="Subtle Emphasis"/> <w:LsdException Locked="false" Priority="21" QFormat="true" Name="Intense Emphasis"/> <w:LsdException Locked="false" Priority="31" QFormat="true" Name="Subtle Reference"/> <w:LsdException Locked="false" Priority="32" QFormat="true" Name="Intense Reference"/> <w:LsdException Locked="false" Priority="33" QFormat="true" Name="Book Title"/> <w:LsdException Locked="false" Priority="37" SemiHidden="true" UnhideWhenUsed="true" Name="Bibliography"/> <w:LsdException Locked="false" Priority="39" SemiHidden="true" UnhideWhenUsed="true" QFormat="true" Name="TOC Heading"/> <w:LsdException Locked="false" Priority="41" Name="Plain Table 1"/> <w:LsdException Locked="false" Priority="42" Name="Plain Table 2"/> <w:LsdException Locked="false" Priority="43" Name="Plain Table 3"/> <w:LsdException Locked="false" Priority="44" Name="Plain Table 4"/> <w:LsdException Locked="false" Priority="45" Name="Plain Table 5"/> <w:LsdException Locked="false" Priority="40" Name="Grid Table Light"/> <w:LsdException Locked="false" Priority="46" Name="Grid Table 1 Light"/> <w:LsdException Locked="false" Priority="47" Name="Grid Table 2"/> <w:LsdException Locked="false" Priority="48" Name="Grid Table 3"/> <w:LsdException Locked="false" Priority="49" Name="Grid Table 4"/> <w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark"/> <w:LsdException Locked="false" Priority="51" Name="Grid Table 6 Colorful"/> <w:LsdException Locked="false" Priority="52" Name="Grid Table 7 Colorful"/> <w:LsdException Locked="false" Priority="46" Name="Grid Table 1 Light Accent 1"/> <w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 1"/> <w:LsdException Locked="false" Priority="48" 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Name="List Table 7 Colorful Accent 6"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Mention"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Smart Hyperlink"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Hashtag"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Unresolved Mention"/> </w:LatentStyles> </xml><![endif]--><!-- [if gte mso 10]> <![endif]--> Integracija zdravstvene informatike u pametne gradove predstavlja transformativni pristup rešavanju izazova urbanih zdravstvenih sistema. Ovaj rad ispituje potencijal zdravstvene informatike za unapređenje zdravstvene usluge, optimizaciju javnog zdravlja i rešavanje neefikasnosti u urbanim sredinama, uz identifikaciju prepreka u njenoj primeni. Uvod analizira razvoj pametnih gradova i pozicionira zdravstvenu informatiku kao ključni alat za upravljanje urbanim zdravstvenim potrebama, uključujući starenje populacije i rastuću učestalost hroničnih bolesti. Teorijski okvir i pregled literature istražuje tehnologije kao što su IoT, Veliki podaci i veštačka inteligencija, uz primere iz Singapura i Barselone, gde su ove tehnologije poboljšale zdravstvene ishode. Metodologija koristi mešoviti pristup koji obuhvata sistematski pregled literature i analizu studija slučaja u gradovima poput Amsterdama i Tokija. Rezultati ukazuju na smanjenje vremena odgovora hitne pomoći za 40% i hospitalizacija za hronične bolesti za 25%, dok izazovi kao što su privatnost podataka, visoki troškovi i interoperabilnost i dalje predstavljaju prepreke. Diskusija ističe značaj okvira za zaštitu privatnosti, partnerstava između javnog i privatnog sektora i inkluzivnih strategija za povećanje digitalne pismenosti. Rad zaključuje potencijalom zdravstvene informatike za izgradnju otpornijih i efikasnijih urbanih zdravstvenih sistema, uz preporuke za dalja istraživanja.
GENERATIVNA AI ZA DESETOGODIŠNJE PREDVIĐANJE MULTIMORBIDITETA: METODOLOŠKA STUDIJA ZASNOVANA NA JAVNO DOSTUPNIM I SINTETIČKIM PODACIMA
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Name="Plain Table 2"/> <w:LsdException Locked="false" Priority="43" Name="Plain Table 3"/> <w:LsdException Locked="false" Priority="44" Name="Plain Table 4"/> <w:LsdException Locked="false" Priority="45" Name="Plain Table 5"/> <w:LsdException Locked="false" Priority="40" Name="Grid Table Light"/> <w:LsdException Locked="false" Priority="46" Name="Grid Table 1 Light"/> <w:LsdException Locked="false" Priority="47" Name="Grid Table 2"/> <w:LsdException Locked="false" Priority="48" Name="Grid Table 3"/> <w:LsdException Locked="false" Priority="49" Name="Grid Table 4"/> <w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark"/> <w:LsdException Locked="false" Priority="51" Name="Grid Table 6 Colorful"/> <w:LsdException Locked="false" Priority="52" Name="Grid Table 7 Colorful"/> <w:LsdException Locked="false" Priority="46" Name="Grid Table 1 Light Accent 1"/> <w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 1"/> <w:LsdException Locked="false" Priority="48" 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Locked="false" Priority="50" Name="List Table 5 Dark Accent 1"/> <w:LsdException Locked="false" Priority="51" Name="List Table 6 Colorful Accent 1"/> <w:LsdException Locked="false" Priority="52" Name="List Table 7 Colorful Accent 1"/> <w:LsdException Locked="false" Priority="46" Name="List Table 1 Light Accent 2"/> <w:LsdException Locked="false" Priority="47" Name="List Table 2 Accent 2"/> <w:LsdException Locked="false" Priority="48" Name="List Table 3 Accent 2"/> <w:LsdException Locked="false" Priority="49" Name="List Table 4 Accent 2"/> <w:LsdException Locked="false" Priority="50" Name="List Table 5 Dark Accent 2"/> <w:LsdException Locked="false" Priority="51" Name="List Table 6 Colorful Accent 2"/> <w:LsdException Locked="false" Priority="52" Name="List Table 7 Colorful Accent 2"/> <w:LsdException Locked="false" Priority="46" Name="List Table 1 Light Accent 3"/> <w:LsdException Locked="false" Priority="47" Name="List Table 2 Accent 3"/> <w:LsdException Locked="false" Priority="48" Name="List Table 3 Accent 3"/> <w:LsdException Locked="false" Priority="49" Name="List Table 4 Accent 3"/> <w:LsdException Locked="false" Priority="50" Name="List Table 5 Dark Accent 3"/> <w:LsdException Locked="false" Priority="51" Name="List Table 6 Colorful Accent 3"/> <w:LsdException Locked="false" Priority="52" Name="List Table 7 Colorful Accent 3"/> <w:LsdException Locked="false" Priority="46" Name="List Table 1 Light Accent 4"/> <w:LsdException Locked="false" Priority="47" Name="List Table 2 Accent 4"/> <w:LsdException Locked="false" Priority="48" Name="List Table 3 Accent 4"/> <w:LsdException Locked="false" Priority="49" Name="List Table 4 Accent 4"/> <w:LsdException Locked="false" Priority="50" Name="List Table 5 Dark Accent 4"/> <w:LsdException Locked="false" Priority="51" Name="List Table 6 Colorful Accent 4"/> <w:LsdException Locked="false" Priority="52" Name="List Table 7 Colorful Accent 4"/> <w:LsdException Locked="false" Priority="46" Name="List Table 1 Light Accent 5"/> <w:LsdException Locked="false" Priority="47" Name="List Table 2 Accent 5"/> <w:LsdException Locked="false" Priority="48" Name="List Table 3 Accent 5"/> <w:LsdException Locked="false" Priority="49" Name="List Table 4 Accent 5"/> <w:LsdException Locked="false" Priority="50" Name="List Table 5 Dark Accent 5"/> <w:LsdException Locked="false" Priority="51" Name="List Table 6 Colorful Accent 5"/> <w:LsdException Locked="false" Priority="52" Name="List Table 7 Colorful Accent 5"/> <w:LsdException Locked="false" Priority="46" Name="List Table 1 Light Accent 6"/> <w:LsdException Locked="false" Priority="47" Name="List Table 2 Accent 6"/> <w:LsdException Locked="false" Priority="48" Name="List Table 3 Accent 6"/> <w:LsdException Locked="false" Priority="49" Name="List Table 4 Accent 6"/> <w:LsdException Locked="false" Priority="50" Name="List Table 5 Dark Accent 6"/> <w:LsdException Locked="false" Priority="51" Name="List Table 6 Colorful Accent 6"/> <w:LsdException Locked="false" Priority="52" Name="List Table 7 Colorful Accent 6"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Mention"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Smart Hyperlink"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Hashtag"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Unresolved Mention"/> </w:LatentStyles> </xml><![endif]--><!-- [if gte mso 10]> <![endif]--> Uvod/Cilj:Cilj rada je da predstavi metodološki okvir za desetogodišnje predviđanje multimorbiditeta pomoću generativnog, sekvencijalnog modela zasnovanog na transformer arhitekturi, uz potpuno oslanjanje na javno dostupne i sintetičke podatke, bez obrade identifikabilnih podataka pacijenata. Metode:Sprovedena je metodološka studija sa primarnom obukom i evaluacijom na Synthea sintetičkoj kohorti (≥100.000 zapisa), uz tehničke provere na MIMIC-III (de-identifikovani realni podaci intenzivne nege). Ishodi (≥1.000) su definisani mapiranjem ICD-10/ICD-10-CM kodova u PheCode kategorije. Model je transformer sa multitask izlazima (po jedan za svaki cilj) i vremenskim ugradnjama, sa evaluacijom diskriminacije (AUPRC, AUROC), kalibracije (Brier, intercept/nagib) i kliničke korisnosti (Decision Curve Analysis). Sprovedene su analize osetljivosti i osnovne provere pravičnosti (pol, starost). Rezultati:Model je postigao najbolje rezultate u kardiometaboličkom i onkološkom domenu, umerene u respiratornim/bubrežnim, a skromnije u mentalnim/infektivnim ishodima. Kalibracija je bila dobra u srednjim opsezima rizika; DCA je pokazala pozitivnu neto korist u pragovima relevantnim za oportunistički skrining (≈5–15% desetogodišnjeg rizika). Analize osetljivosti potvrdile su stabilnost rang-performansi na promenama pragova retkosti i dužine istorije, bez dokaza o značajnom „label leakage”-u. Zaključak:Prikazan je reproducibilan i etički prihvatljiv pristup dugoročnoj višebolećinskoj prognozi rizika koristeći generativni transformer na javnim/sintetičkim skupovima. Ovaj „barometar zdravlja“ može da podrži trijažu i personalizovanu prevenciju, uz preporuku obavezne eksterne validacije, lokalne re-kalibracije i nadzora pravičnosti pre kliničke primene.
Uticaj tocilizumaba na tok i ishod lečenja pacijenata sa COVID-19 pneumonijom - iskustvo bolnice sekundarnog nivoa
Uvod: Važnu ulogu u progresiji COVID-19 pneumonije ima IL-6. Za blokadu njegove aktivnosti koristi se monoklonsko antitelo tocilizumab. Cilj istraživanja je bio ispitivanje uticaja tocilizumaba na klinički tok, laboratorijske parametre, radiografske promene kod pacijenata sa COVID-19 pneumonijom i odredjivanje prediktorna letalnog ishoda. Metod: Retrogradno su ispitani podaci uzeti 340 pacijenata sa COVID-19 pneumonijom lečenih tocilizumabom. Podaci su uzeti na dan primene tocilizumaba i pet dana nakon toga. Ispitivani su pol, uzrast, klinički tok i ishod bolesti, prisustvo komorbiditeta, nastanak bolničkih infekcija, metod oksigenacije i radiografske promene. Parametri su upoređivani u odnosu na smrtnost. Statistička obrada izvršena je pomoću programa SPSS, verzija 25.0. Rezultati: Prosečna starost pacijenata iznosila je 66,22 ± 11,37 godina, a 66,4% su činili muškarci. Komorbiditete je imalo 65,4% pacijenata, najčešće arterijsku hipertenziju (56,2%). Bolničke infekcije registrovane su kod 8,5% pacijenata, pri čemu je bakterijska pneumonija bila najčešća (34,5%). Neinvazivna oksigenoterapija primenjena je kod 64,1% bolesnika, dok je 24% zahtevalo mehaničku ventilaciju. Pre primene tocilizumaba 23,8% pacijenata imalo je R/F indeks <200, a nakon terapije 15,9%. Radiografski skor (CXR-SS) pokazao je teške promene kod 71,5%, a veoma teške kod 27,1% pacijenata. Smrtnost je iznosila 21,8%, pri čemu je 78,3% preminulih bilo starije od 65 godina. Veoma težak CXR-SS imalo je 75,7% preminulih. Zaključak: Tocilizumab je doveo do poboljšanja respiratorne funkcije i smanjenja inflamatornih biohemijskih parametara. Starost iznad 65 godina, prisustvo komorbiditeta i bolničkih infekcija povezani su sa većom smrtnošću, dok su izražene radiografske promene i potreba za mehaničkom ventilacijom glavni prediktori smrtnog ishoda.
PRISTUP ZDRAVOJ HRANI I GOJAZNOST ODRASLIH: SEKUNDARNA SINTEZA DOKAZA SA KLINIČKIM IMPLIKACIJAMA ZA ENDOKRINOLOGIJU
Pozadina: Gojaznost je visoko prevalentna I determinisana, pored individualnih faktora, I karakteristikama okruženja hrane. Razumevanje kako dostupnost zdrave hrane utiče na rizik gojaznosti važno je za endokrinološku praksu. Cilj: Sumarno prikazati odnos između pristupa zdravoj hrani I gojaznosti odraslih te istaknuti kliničke I javnozdravstvene implikacije. Metode: Fokusirana sekundarna sinteza zasnovana na savremenoj sistematskoj recenziji I meta-analizi, dopunjena reprezentativnim opservacionim studijama. Ekspozicije su operativizovane kao proksimitet, gustina I kompozitni indeksi (npr. RFEI). Ekstrahovani su objedinjeni odnosi izgleda (OR) sa 95% intervalima poverenja; nije rađena nova re-meta-analiza. Kvalitet I pristrasnost razmatrani su u okvirima PRISMA I domena ROBINS-I. Rezultati: Dosledno se uočava da je bliža dostupnost brze hrane povezana sa višim izgledima za gojaznost (≈OR 1,15), dok su proksimitet supermarketima I veća gustina prodavnica svežih namirnica povezani sa nižim izgledima (≈OR 0,90 I ≈OR 0,93). Kompozitni indeksi su češće bliski neutralnom efektu. Heterogenost zavisi od definicije zone izlaganja (signal jasniji u širim baferima, npr. 1,5–3 km) i od socioekonomskih uslova. Iako su efekti umereni na nivou pojedinca, populaciono mogu biti klinički značajni. Zaključak: Prostorna dostupnost zdrave hrane merljivo je povezana sa rizikom gojaznosti. Endokrinološka praksa treba da objedini individualno savetovanje sa „mapiranjem“ lokalnih izvora svežih namirnica I upućivanjem na realno dostupne resurse. Javne politike koje smanjuju dominaciju nezdrave ponude I podstiču otvaranje/održivost prodajnih mesta sa zdravijom hranom imaju potencijal za značajan populacioni benefit. Potrebna je standardizacija metrika izlaganja I evaluacija intervencija u realnom okruženju.
Korelacija vrednosti frakcionog klirensa i optičkog ishoda korekcije kratkovidosti LASIK metodom
Pulsevima excimer lasera LASIK metodom vrši se ablatiranje strome rožnjače čime se postiže njeno remodelovanje do željenih optičkih karakteristika. Pored korigovanja ametropije, poželjno je svesti indukciju optičkih aberacija višeg reda (HOA) na najmanju moguću meru, jer one utiču na pojavu zablještenja i zamagljenja u uslovima noćnog gledanja. Frakcioni klirens (FC) predstavlja odnos dijametra tretirane optičke zone (OZ) i zenice u skotopskim uslovima osvetljenja. Cilj ovog rada je da se ispita povezanost proširenja dijametra tretirane OZ i povećanja indeksa FC na postoperativni nivo HOA. Prospektivna studija je obuhvatila 37 ispitanika (74 oka) sa miopijom koji su tretirani LASIK metodom. Oko sa većom vrednošću rezidualnog stromalnog ležišta tretirano je dijametrom OZ 7,0 mm, a drugo oko istog pacijenta dijametrom OZ 6,5 mm. Nakon 6 meseci izvršena je objektivna evaluacija optičkog ishoda Analyzer aparatom. Srednja vrednost FC u grupi očiju tretiranih sa OZ 6,5 mm iznosi 2,138 (SD 0,30), a u grupi tretiranoj OZ 7,0 mm iznosi 2,325 (SD 0,37), sa statistički visoko značajnom razlikom (t=3,64; p<0,001). Utvrđena je manja indukcija svih izmerenih HOA kada je tretirana šira OZ od 7,0 mm, pri čemu je statistički najznačajnije smanjenje uočeno kod indukcije sferne aberacije. Povećanje indeksa FC je proporcionalno proširenju dijametra tretirane OZ. Sa povećanjem vrednosti FC smanjuje se nivo svih HOA nakon LASIK procedure, a najznačajnije smanjenje se uočava kod indukcije sferne aberacije. Proširenje OZ na 7,0 mm, kada to strukturne karakteristike rožnjače dozvoljavaju, poboljšava postoperativni optički ishod.
POJAVA GREJVSOVE ORBITOPATIJE NAKON OPERATIVNOG LEČENJA AUTOIMUNOG HIPERTIREOIDIZMA
Grejvsova orbitopatija (GO) je najčešća manifestacija autoimunog hipertireoidizma. Javlja se najčešće u prvoj godini posle postavljanja dijagnoze, a retko može da se javi i kod eutireoidnih i hipotireoidnih pacijenta. Nakon totalne tireoidektomije se može razviti kod oko 10-20% pacijenata, simptomi se obično javljaju nekoliko meseci do godinu dana od operacije. Rizik je veći kod pacijenata sa visokim titrom anti TSH recptorskih antitela (TrAb), kod pušača i pacijenta koji nisu pravovremeno započeli supstitucionu terapiju levotiroksinom. Prva linija lečenja je primena intravenskih kortikosteroida. Bolesnica starosti 69 godina sa autoimunom tireoidnom bolešću se prezentovala autoimunim hipertireodizmom, započela lečenje tiresupresivnom terapijom u trajanju od 5 godina bez razvoja orbitopatije tokom lečenja. Obzirom na nepostizanje stabilizacije bolesti, sprovedena druga linija lečenja, urađena totalna tireoidektomija sa posledičnim hipotireoidizmom i hipoparatireoidizmom. U daljem toku lečenja adekvatno supstituisana levotiroksinom, alfakalcidolom i kalcijumom. Operativno lečen adenokarcinom sigme, postoperativno primala hemioterapiju. Obolela 9 godina nakon operacije štitaste žlezde od COVID infekcije, nakon sprovedene redovne vakcinacije, lečena primenom biološke terapije, monoklonsko antitelo na “spike” protein SARS CoV 2 i antivirusnom terapijom. Nakon 11 godina od sprovedne totalne tireoidektomije dolazi do pojave srednje teške forme GO, umerenog stepena kliničke aktivnosti sa nestalnim dvoslikama, sa povišenim titrom TrAb. Primenom intravenske kortiroksteroidne terapije, postiže se zadovoljavajući terapijski odgovor. Pojava GO, kao najčešće ekstratireoidne manifestacije autoimunog hipertireoidizma, se izuzetno retko javlja nakon više godina od početka lečnja hipertireoidizma, a još ređe nakon sprovođenja operativnog lečenja autoimunog hipertireoidizma. COVID infekcija i primena biološke terapije može biti okidač za pokretanje autoimunog procesa, kao i pridružene bolesti.
Upravljanje kvalitetom u medicinskom akademskom obrazovanju: Fokus na Srbiju
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Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Web 3"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Balloon Text"/> <w:LsdException Locked="false" Priority="39" Name="Table Grid"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Theme"/> <w:LsdException Locked="false" SemiHidden="true" Name="Placeholder Text"/> <w:LsdException Locked="false" Priority="1" QFormat="true" Name="No Spacing"/> <w:LsdException Locked="false" Priority="60" Name="Light Shading"/> <w:LsdException Locked="false" Priority="61" Name="Light List"/> <w:LsdException Locked="false" Priority="62" Name="Light Grid"/> <w:LsdException Locked="false" Priority="63" Name="Medium Shading 1"/> <w:LsdException Locked="false" Priority="64" Name="Medium Shading 2"/> <w:LsdException Locked="false" Priority="65" Name="Medium List 1"/> <w:LsdException Locked="false" Priority="66" Name="Medium List 2"/> <w:LsdException Locked="false" Priority="67" Name="Medium Grid 1"/> <w:LsdException Locked="false" Priority="68" Name="Medium Grid 2"/> <w:LsdException Locked="false" Priority="69" Name="Medium Grid 3"/> <w:LsdException Locked="false" Priority="70" Name="Dark List"/> <w:LsdException Locked="false" Priority="71" Name="Colorful Shading"/> <w:LsdException Locked="false" Priority="72" Name="Colorful List"/> <w:LsdException Locked="false" Priority="73" Name="Colorful Grid"/> <w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 1"/> <w:LsdException Locked="false" Priority="61" Name="Light List Accent 1"/> <w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 1"/> <w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 1"/> <w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 1"/> <w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 1"/> <w:LsdException Locked="false" SemiHidden="true" Name="Revision"/> <w:LsdException Locked="false" Priority="34" QFormat="true" Name="List Paragraph"/> <w:LsdException Locked="false" Priority="29" QFormat="true" Name="Quote"/> <w:LsdException Locked="false" Priority="30" QFormat="true" Name="Intense Quote"/> <w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 1"/> <w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 1"/> <w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 1"/> <w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 1"/> <w:LsdException Locked="false" Priority="70" Name="Dark List Accent 1"/> <w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 1"/> <w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 1"/> <w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 1"/> <w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 2"/> <w:LsdException Locked="false" Priority="61" Name="Light List Accent 2"/> <w:LsdException 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<w:LsdException Locked="false" Priority="61" Name="Light List Accent 3"/> <w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 3"/> <w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 3"/> <w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 3"/> <w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 3"/> <w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 3"/> <w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 3"/> <w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 3"/> <w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 3"/> <w:LsdException Locked="false" Priority="70" Name="Dark List Accent 3"/> <w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 3"/> <w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 3"/> <w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 3"/> <w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 4"/> <w:LsdException Locked="false" Priority="61" Name="Light List Accent 4"/> <w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 4"/> <w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 4"/> <w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 4"/> <w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 4"/> <w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 4"/> <w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 4"/> <w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 4"/> <w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 4"/> <w:LsdException Locked="false" Priority="70" Name="Dark List Accent 4"/> <w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 4"/> <w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 4"/> <w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 4"/> <w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 5"/> <w:LsdException Locked="false" Priority="61" Name="Light List Accent 5"/> <w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 5"/> <w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 5"/> <w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 5"/> <w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 5"/> <w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 5"/> <w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 5"/> <w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 5"/> <w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 5"/> <w:LsdException Locked="false" Priority="70" Name="Dark List Accent 5"/> <w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 5"/> <w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 5"/> <w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 5"/> <w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 6"/> <w:LsdException Locked="false" Priority="61" Name="Light List Accent 6"/> <w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 6"/> <w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 6"/> <w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 6"/> <w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 6"/> <w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 6"/> <w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 6"/> <w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 6"/> <w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 6"/> <w:LsdException Locked="false" Priority="70" Name="Dark List Accent 6"/> <w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 6"/> <w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 6"/> <w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 6"/> <w:LsdException Locked="false" Priority="19" QFormat="true" Name="Subtle Emphasis"/> <w:LsdException Locked="false" Priority="21" QFormat="true" Name="Intense Emphasis"/> <w:LsdException Locked="false" Priority="31" QFormat="true" Name="Subtle Reference"/> <w:LsdException Locked="false" Priority="32" QFormat="true" Name="Intense Reference"/> <w:LsdException Locked="false" Priority="33" QFormat="true" Name="Book Title"/> <w:LsdException Locked="false" Priority="37" SemiHidden="true" UnhideWhenUsed="true" Name="Bibliography"/> <w:LsdException Locked="false" Priority="39" SemiHidden="true" UnhideWhenUsed="true" QFormat="true" Name="TOC Heading"/> <w:LsdException Locked="false" Priority="41" Name="Plain Table 1"/> <w:LsdException Locked="false" Priority="42" Name="Plain Table 2"/> <w:LsdException Locked="false" Priority="43" Name="Plain Table 3"/> <w:LsdException Locked="false" Priority="44" Name="Plain Table 4"/> <w:LsdException Locked="false" Priority="45" Name="Plain Table 5"/> <w:LsdException Locked="false" Priority="40" Name="Grid Table Light"/> <w:LsdException Locked="false" Priority="46" Name="Grid Table 1 Light"/> <w:LsdException Locked="false" Priority="47" Name="Grid Table 2"/> <w:LsdException Locked="false" Priority="48" Name="Grid Table 3"/> <w:LsdException Locked="false" Priority="49" Name="Grid Table 4"/> <w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark"/> <w:LsdException Locked="false" Priority="51" Name="Grid Table 6 Colorful"/> <w:LsdException Locked="false" Priority="52" Name="Grid Table 7 Colorful"/> <w:LsdException Locked="false" Priority="46" Name="Grid Table 1 Light Accent 1"/> <w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 1"/> <w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 1"/> <w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 1"/> <w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 1"/> <w:LsdException Locked="false" Priority="51" Name="Grid Table 6 Colorful Accent 1"/> <w:LsdException Locked="false" Priority="52" Name="Grid Table 7 Colorful Accent 1"/> <w:LsdException Locked="false" Priority="46" Name="Grid Table 1 Light Accent 2"/> <w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 2"/> <w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 2"/> <w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 2"/> <w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 2"/> <w:LsdException Locked="false" Priority="51" Name="Grid Table 6 Colorful Accent 2"/> <w:LsdException Locked="false" Priority="52" Name="Grid Table 7 Colorful Accent 2"/> <w:LsdException Locked="false" Priority="46" Name="Grid Table 1 Light Accent 3"/> <w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 3"/> <w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 3"/> <w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 3"/> <w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 3"/> <w:LsdException Locked="false" Priority="51" Name="Grid Table 6 Colorful Accent 3"/> <w:LsdException Locked="false" Priority="52" Name="Grid Table 7 Colorful Accent 3"/> <w:LsdException Locked="false" Priority="46" Name="Grid Table 1 Light Accent 4"/> <w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 4"/> <w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 4"/> <w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 4"/> <w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 4"/> <w:LsdException Locked="false" Priority="51" Name="Grid Table 6 Colorful Accent 4"/> <w:LsdException Locked="false" Priority="52" Name="Grid Table 7 Colorful Accent 4"/> <w:LsdException Locked="false" Priority="46" Name="Grid Table 1 Light Accent 5"/> <w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 5"/> <w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 5"/> <w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 5"/> <w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 5"/> <w:LsdException Locked="false" Priority="51" Name="Grid Table 6 Colorful Accent 5"/> <w:LsdException Locked="false" Priority="52" Name="Grid Table 7 Colorful Accent 5"/> <w:LsdException Locked="false" Priority="46" Name="Grid Table 1 Light Accent 6"/> <w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 6"/> <w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 6"/> <w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 6"/> <w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 6"/> <w:LsdException Locked="false" Priority="51" Name="Grid Table 6 Colorful Accent 6"/> <w:LsdException Locked="false" Priority="52" Name="Grid Table 7 Colorful Accent 6"/> <w:LsdException Locked="false" Priority="46" Name="List Table 1 Light"/> <w:LsdException Locked="false" Priority="47" Name="List Table 2"/> <w:LsdException Locked="false" Priority="48" Name="List Table 3"/> <w:LsdException Locked="false" Priority="49" Name="List Table 4"/> <w:LsdException Locked="false" Priority="50" Name="List Table 5 Dark"/> <w:LsdException Locked="false" Priority="51" Name="List Table 6 Colorful"/> <w:LsdException Locked="false" Priority="52" Name="List Table 7 Colorful"/> <w:LsdException Locked="false" Priority="46" Name="List Table 1 Light Accent 1"/> <w:LsdException Locked="false" Priority="47" Name="List Table 2 Accent 1"/> <w:LsdException Locked="false" Priority="48" Name="List Table 3 Accent 1"/> <w:LsdException Locked="false" Priority="49" Name="List Table 4 Accent 1"/> <w:LsdException Locked="false" Priority="50" Name="List Table 5 Dark Accent 1"/> <w:LsdException Locked="false" Priority="51" Name="List Table 6 Colorful Accent 1"/> <w:LsdException Locked="false" Priority="52" Name="List Table 7 Colorful Accent 1"/> <w:LsdException Locked="false" Priority="46" Name="List Table 1 Light Accent 2"/> <w:LsdException Locked="false" Priority="47" Name="List Table 2 Accent 2"/> <w:LsdException Locked="false" Priority="48" Name="List Table 3 Accent 2"/> <w:LsdException Locked="false" Priority="49" Name="List Table 4 Accent 2"/> <w:LsdException Locked="false" Priority="50" Name="List Table 5 Dark Accent 2"/> <w:LsdException Locked="false" Priority="51" Name="List Table 6 Colorful Accent 2"/> <w:LsdException Locked="false" Priority="52" Name="List Table 7 Colorful Accent 2"/> <w:LsdException Locked="false" Priority="46" Name="List Table 1 Light Accent 3"/> <w:LsdException Locked="false" Priority="47" Name="List Table 2 Accent 3"/> <w:LsdException Locked="false" Priority="48" Name="List Table 3 Accent 3"/> <w:LsdException Locked="false" Priority="49" Name="List Table 4 Accent 3"/> <w:LsdException Locked="false" Priority="50" Name="List Table 5 Dark Accent 3"/> <w:LsdException Locked="false" Priority="51" Name="List Table 6 Colorful Accent 3"/> <w:LsdException Locked="false" Priority="52" Name="List Table 7 Colorful Accent 3"/> <w:LsdException Locked="false" Priority="46" Name="List Table 1 Light Accent 4"/> <w:LsdException Locked="false" Priority="47" Name="List Table 2 Accent 4"/> <w:LsdException Locked="false" Priority="48" Name="List Table 3 Accent 4"/> <w:LsdException Locked="false" Priority="49" Name="List Table 4 Accent 4"/> <w:LsdException Locked="false" Priority="50" Name="List Table 5 Dark Accent 4"/> <w:LsdException Locked="false" Priority="51" Name="List Table 6 Colorful Accent 4"/> <w:LsdException Locked="false" Priority="52" Name="List Table 7 Colorful Accent 4"/> <w:LsdException Locked="false" Priority="46" Name="List Table 1 Light Accent 5"/> <w:LsdException Locked="false" Priority="47" Name="List Table 2 Accent 5"/> <w:LsdException Locked="false" Priority="48" Name="List Table 3 Accent 5"/> <w:LsdException Locked="false" Priority="49" Name="List Table 4 Accent 5"/> <w:LsdException Locked="false" Priority="50" Name="List Table 5 Dark Accent 5"/> <w:LsdException Locked="false" Priority="51" Name="List Table 6 Colorful Accent 5"/> <w:LsdException Locked="false" Priority="52" Name="List Table 7 Colorful Accent 5"/> <w:LsdException Locked="false" Priority="46" Name="List Table 1 Light Accent 6"/> <w:LsdException Locked="false" Priority="47" Name="List Table 2 Accent 6"/> <w:LsdException Locked="false" Priority="48" Name="List Table 3 Accent 6"/> <w:LsdException Locked="false" Priority="49" Name="List Table 4 Accent 6"/> <w:LsdException Locked="false" Priority="50" Name="List Table 5 Dark Accent 6"/> <w:LsdException Locked="false" Priority="51" Name="List Table 6 Colorful Accent 6"/> <w:LsdException Locked="false" Priority="52" Name="List Table 7 Colorful Accent 6"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Mention"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Smart Hyperlink"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Hashtag"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Unresolved Mention"/> </w:LatentStyles> </xml><![endif]--><!-- [if gte mso 10]> <![endif]--> Uvod: Ova studija je analizirala prakse upravljanja kvalitetom u srpskim strukovnim višim medicinskim školama, fokusirajući se na njihovu usklađenost sa nacionalnim i međunarodnim standardima i specifičnim izazovima praktično orijentisanog medicinskog obrazovanja. Metode: Mešoviti metodski dizajn primenjen je u pet akreditovanih stručnih institucija. Kvantitativni podaci obuhvatali su akreditacione dokumente, institucionalne indikatore (stope upisa, napuštanja i zaposlenosti diplomiranih studenata) i strukturirane ankete među nastavnim osobljem (n = 124) i studentima (n = 298). Kvalitativni podaci su dobijeni putem polustrukturiranih intervjua sa direktorima, šefovima odeljenja i koordinatorima za obezbeđivanje kvaliteta (n = 18), osam fokus grupa studenata i analize internih politika obezbeđivanja kvaliteta i strateških planova. Rezultati: Kvantitativni nalazi su pokazali umereno opšte zadovoljstvo među osobljem i studentima, sa višim ocenama za praktičnu obuku i relevantnost nastavnog plana i programa i nižim ocenama za infrastrukturu, opremu i transparentnost procene. Stope napuštanja studija ostale su relativno niske, dok je zaposlenost diplomaca generalno bila visoka. Kvalitativni podaci istakli su stalna ograničenja resursa, nedostatak osoblja i neravnomerno usvajanje tehnologija e-učenja i simulacije. Akreditacija je široko shvaćena kao neophodna, ali se često pristupala kao periodična vežba usklađenosti, a ne kao pokretač kontinuiranog poboljšanja. Mehanizmi za povratne informacije zainteresovanih strana su postojali, ali su se nedosledno koristili, što je rezultiralo slabim povratnim informacijama. Diskusija: Visoke medicinske škole u ​​Srbiji pokazuju otpornost i snažnu praktičnu obuku uprkos sistemskim i finansijskim ograničenjima. Jačanje strateških ulaganja u infrastrukturu, ugrađivanje kontinuiranih procesa obezbeđivanja kvaliteta u svakodnevnu praksu, modernizacija metoda procene i proširenje digitalnih i telemedicinskih okruženja za učenje ključni su prioriteti za poboljšanje kvaliteta obrazovanja i pripremljenosti zdravstvene radne snage.