The socioeconomic impact of cancer on patients and their relatives: Organisation of European Cancer Institutes task force consensus recommendations on conceptual framework, taxonomy, and research directions.

Loss of income and out-of-pocket expenditures are important causes of financial hardship in many patients with cancer, even in high-income countries. The far-reaching consequences extend beyond the patients themselves to their relatives, including caregivers and dependents. European research to date has been limited and is hampered by the absence of a coherent theoretical framework and by heterogeneous methods and terminology. To address these shortages, a task force initiated by the Organisation of European Cancer Institutes (OECI) produced 25 recommendations, including a comprehensive definition of socioeconomic impact from the perspective of patients and their relatives, a conceptual framework, and a consistent taxonomy linked to the framework. The OECI task force consensus statement highlights directions for future research with a view towards policy relevance. Beyond descriptive studies into the dimension of the problem, individual severity and predictors of vulnerability should be explored. It is anticipated that the consensus recommendations will facilitate and enhance future research efforts into the socioeconomic impact of cancer and cancer care, providing a crucial reference point for the development and validation of patient-reported outcome instruments aimed at measuring its broader effects.

[Surgical treatment of lower jaw pseudoarthrosis as a result of fracture non-treatment following tooth extraction]. / Kirursko lijecenje pseudoartroze donje celjusti kao posljedice nelijecenog prijeloma nakon vadenja zuba.

Fracture of the lower jaw following tooth extraction is a rare and severe complication, occurring most often in the preangular region following third molar extraction. When left untreated, pseudoarthrosis can occur. Symptoms show a wide variance, including pathologic mobility, pain and infection, as well as sometimes trismus before and following surgical treatment. The possible complications of pseudoarthrosis may be malnutrition, jaw deformity and long-term disability. Treatment options range from prescription of a soft diet in case of simple fracture to surgical treatment by open reduction and internal fixation. A case is presented where a 47-year-old male suffered from painful perimandibular swelling and complained of "instability" of the lower jaw as well as hypoesthesia in the area of the left mental nerve. Case history revealed that he had had extraction of the lower left second molar (tooth 37) four months before. Following clinical and radiographic examination he was diagnosed with non-diagnosed and/or non-treated lower jaw fracture. The patient was surgically treated using an oseosynthetic plate to ensure stability. The postoperative protocol showed satisfactory results. Bone growth in the fracture line was recorded in the follow up. However, due to the four-month period of pseudoarthrosis and infection, the plate was removed much later than it would have been the case if surgical treatment had been performed immediately following the fracture. The delayed diagnosis of this fracture demonstrates the necessity of radiologic control when a fracture is suspected following tooth extraction. When a patient shows symptoms inconsistent with those following tooth extraction, surgical consultation is recommended.

[Founding and development of the Croatian Health Information System]. / Uspostava i razvoj zdravstvenog Informacijskog Sustava Republike Hrvatske.

Information systems, either computer or paper based, are the key to business effectiveness and efficiency of healthcare organizations. The rationale of starting a large healthcare informatics project by the Ministry of Health and Welfare may be argued by two needs: (1) the need of medical data transformation into the information required for public health policy decision-making; and (2) measures in the field of health and pharmacoeconomics, i.e. systematic surveillance of healthcare costs that define the prospects for savings without lowering the level of service (estimated at 20%-30% of potential savings), along with the need of transparency and adoption of European Union directives and standards. Implementation of the proposed system results in two groups of fundamental functions: (1) the creation of a central public health information system which facilitates real-time tracking of primary healthcare cost generators, which in turn are used for creating health economics policy, and (2) to automatize the process of generating a consolidated national health budget including the Croatian Institute of Health Insurance and hospitals as well as consolidated financial reports for all those involved in the healthcare system. The model of the National Health Information System of the Republic of Croatia is described.

[Information system in primary health care]. / Informacijski sustav u primarnoj zdravstvenoj zastiti.

The Croatian Ministry of Health started a health care system computerization project aimed at strengthening the collaboration among health care institutions, expert groups and individual health care providers. A tender for informatic system for Primary Health Care (PHC) general practice, pediatrics and gynecology, a vital prerequisite for project realization, has now been closed. Some important reasons for undertaking the project include rationalization of drug utilization, savings through a reduced use of specialists, consultants and hospitalization, then achievement of better cooperation, work distribution, result linking, data quality improvement (by standardization), and ensuring proper information-based decision making. Keeping non-standardized and thus difficult to process data takes too much time of the PHC team time. Since, however, a vast amount of data are collected on only a few indicators, some important information may remain uncovered. Although decisions made by health authorities should rely on evidence and processed information, the authorities spend most of the time working with raw data from which their decisions ultimately derive. The Informatic Technology (IT) in PHC is expected to enable a different approach. PHC teams should be relieved from the tedious task of data gathering and the authorities enabled to work with the information rather than data. The Informatics Communication Technology (ICT) system consists of three parts: hardware (5000 personal computers for work over the Internet), operative system with basic software (editor, etc.), and PHC software for PHC teams. At the national level (National Public Health Informatics System), a software platform will be built for data collection, analysis and distribution. This data collection will be based on the International Classification of Primary Care (ICPC-2) standard to ensure the utilization of medical records and quality assessment. The system permits bi-directional data exchange between a central database and sources at different levels, across the spectrum from basic PHC teams to local authorities. This will enable data collection control, comparisons with national averages and prompt distribution of information over the Internet. The investment into IT is a strategic imperative having no alternative. A cost/benefit analysis has shown its operation in the PHC system to return the investment in two years. As defined according to the Project priorities (with measurable objectives), the use of new technologies will be introduced by stages.

[ICPC-2--international classification of primary health care and its application in Croatian health care]. / ICPC-2--medunarodna klasifikacija primarne zdravstvene zastite i njena primjena u zdravstvu Hrvatske.

A consensus reached by the medical profession, Croatian Institute of Health Insurance, Croatian Institute of Public Health, and Ministry of Health constitutes a solution to the problem of a data standard required in building an information system for primary health care. This consists of accepting ICPC-2 as a data standard for our Family Medicine, Pediatrics and Women's Health. The classification structure of the International Classification of Primary Care allows, recommends and urges that special codes be established by individual states or local authorities when registering patients' reasons for seeking medical aid or medical procedures. Namely, it urges the authorities to set the codes for such reasons about which a state or local agreement or determination has been made. This is the first public presentation of the proposal Croatia's Additions to the International Classification of Primary Care. They are essential to its implementation in our health insurance, health statistics and medical informatics.