ABSTRACT Introduction: Evolocumab is fully human monoclonal antibody which binds to proprotein convertase subtilisin/kexin type 9 (PCSK9), and prevents its blocking effect on recycling of liver low-density lipoprotein (LDL) receptors. Areas covered: The aim of this review is to assess efficacy, safety, and cost-effectiveness of evolocumab in adult patients with high cardiovascular risk. Major research databases MEDLINE, EBSCO, and CENTRAL were systematically searched for relevant study reports. Expert commentary: Even when given in full doses, statins augmented with ezetimibe and cholesterol-binding resins could not reduce cholesterol baseline level for more than 66%, while evolocumab reduces cholesterol level for 75% or even more. Up to now, evolocumab showed good safety profile, and patents tolerate it very well. The abovementioned advantages of evolocumab made it almost ideal drug for hypercholesterolemia, and probably in the future the best drug for secondary prevention of major cardiovascular events. Evolocumab is borderline cost-effective for the treatment of patients with high cardiovascular risk in European countries, while in the U.S.A. it is under debate where the underlying assumption (risk of cardiovascular disease events) determine the true value.

ABSTRACT Introduction:The anticonvulsant activity of cannabinoids attracted much attention in the last decade. Cannabinoids that are currently investigated with the intention of making them drugs for the treatment of epilepsy are cannabidiol, cannabidivarin, Δ9-tetrahydrocannabivarin, and Δ9-tetrahydrocannabinolic acid. Areas covered:In this review, the authors look at the results of preclinical and clinical studies with investigational cannabinoids. Relevant literature was searched for in MEDLINE, SCOPUS, EBSCO, GOOGLE SCHOLAR, and SCINDEX databases. Expert opinion: Preclinical studies confirmed anticonvulsant activity of cannabidiol and cannabidivarin in a variety of epilepsy models. While the results of clinical trials with cannabidivarin are still awaited, cannabidiol showed clear therapeutic benefit and good safety in patients with therapy-resistant seizures associated with Dravet syndrome and in patients with Lennox–Gastaut syndrome who have drop seizures. However, the full therapeutic potential of cannabinoids in treatment-resistant epilepsy needs to be investigated in the near future.

AIMS AND OBJECTIVES To develop and validate a reliable instrument that can measure fear of hospitalisation experienced by outpatients. BACKGROUND After having a diagnosis established, some patients experience sense of fear, unpleasantness and embarrassment due to the possibility to be admitted to a hospital. Currently, there is no available instrument for measuring fear of hospitalisation. DESIGN Cross-sectional study for assessing reliability and validity of a questionnaire. METHOD The questionnaire with 17 items and answers according to the Likert scale was developed during two brainstorming sessions of the research team. Its reliability, validity and temporal stability were tested on the sample of 330 outpatients. The study was multicentric, involving patients from seven cities and three countries. RESULTS Fear of hospitalisation scale showed satisfactory reliability, when rated both by the investigators (Cronbach's alpha .799) and by the patients themselves (Cronbach's alpha .760). It is temporally stable, and both divergent and convergent validity tests had good results. Factorial analysis revealed three domains: fear of being injured, trust to medical staff and fear of losing privacy or autonomy. CONCLUSIONS This study developed new reliable and valid instrument for measuring fear of hospitalisation. RELEVANCE TO CLINICAL PRACTICE Identification of patients with high level of fear of hospitalisation by this instrument should help clinicians to administer measures which may decrease fear and prevent avoidance of healthcare utilisation.

Aim: Research into quality of life has become very important recently, since quality of life is increasingly used to characterise diseases and estimate the efficiency of therapeutics. The aim of this study was to determine significant factors that are associated with the quality of life of patients with schizophrenia accommodated in social welfare institutions. Material and methods: The study was conducted at the Institution for the Accommodation of Adults “Male Pcelice,” Kragujevac, Serbia. It was designed as a cross-sectional study. The quality of life was measured by using five distinct scales. The data on factors that might be associated with the quality of life were obtained from case records and the patients’ questionnaires. The association of every single factor was evaluated by using comparative analysis and the method of multiple linear regression. Results: Multiple linear regression shows that EuroQoL Five-dimensions – Five-Level scale score was associated with gender (B = −0.059 ± 0.021; p = 0.006) and daily dose (B = −0.051 ± 0.015; p = 0.001); Quality of Life Enjoyment and Satisfaction Questionnaire score was associated with the patient’s level of education (B = 2.873 ± 1.054; р = 0.007); the number of prescribed antipsychotics was associated with the Brief Psychiatric Rating Scale score (B = 3.150 ± 1.111; р = 0.007); the physical domain of the World Health Organization Quality of Life-BREF was associated with the year of disease onset (B = −0.142 ± 0.055; р = 0.011) and the daily dose (B = −2.335 ± 0.787; р = 0.004); the psychological domain of the World Health Organization Quality of Life-BREF was associated with gender (B = −2.686 ± 1.216; р = 0.029); the social relationship domain of the World Health Organization Quality of Life-BREF was associated with the level of education (B = 3.109 ± 1.289; р = 0.017) and the number of prescribed antipsychotics (B = −3.297 ± 1.516; р = 0.031); the environment domain of the World Health Organization Quality of Life-BREF was associated with the number of prescribed antipsychotics (B = −1.420 ± 0.653; р = 0,031). Conclusion: The quality of life of patients with schizophrenia was higher in males with a university degree, when the duration of the disease was shorter, negative symptoms were less pronounced, and with fewer side effects. Efforts to improve the quality of life in patients with schizophrenia accommodated in social welfare institutions should be made that could contribute to the prevention of adverse outcomes.

Potentially inappropriate prescribing (PIP) of drugs is defined as the use of drugs whose potential damage can overcome benefits. Elderly patients (65 years and older) with renal insufficiency are at particular risk, because they take a lot of drugs, and for the usage of the same, the patients need to have great knowledge and skills. To identify the risk factors contributing to potentially inappropriate prescribing of drugs in elderly patients with renal insufficiency. The study was designed as an observational case-control study. The research was carried out at the Clinic of Nephrology, Clinical Center Nis, Serbia. The data were collected from the medical files of elderly patients undergoing chronic hemodialysis treatment, as well as by interviewing. The cases were patients in whom the potentially inappropriate prescribing of drugs was determined by Beers criteria, and the controls were patients who used properly prescribed medications. The risk factors for PIP were established by univariant and subsequent ly by multivariate logistic regression. The study included 68 patients older than 65 years who were on chronic hemo-dialysis treatment, 41 (60.3%) of them were men and 27 (39.7%) women. The average age of the studied population was 72.71 ± 5.92 years, among which the youngest patient was 65 and the oldest 85 years old. According to Beers criteria, PIP was found in 14 (21%) patients. A significantly higher number of drugs was given to the patients in whom the potentially inadequate prescription of medication was established (Z = 2.650; p = 0.008). The patients to whom the drugs were potentially inappropriately prescribed had a significantly higher number of comorbidities compared to other patients (χ2 = 2.636; p = 0.008). This study showed that patients who have multiple comorbidities and take multiple drugs are at a substantially greater risk of having at least one drug potentially inadequately prescribed. PIP often results in the occurrence of toxic or side effects, and ultimately damage to the body. Acta Medica Medianae 2018;57(1):12-18.

Summary The aim of this study was to investigate problems with the administration of antipsychotic long-acting injections (LAIs) in patients with schizophrenia. Besides many benefits, long-acting injections have been associated with a number of complications at the site of the injection. The qualitative study included four medical workers and five patients who had been treated with fluphenazine, haloperidol, risperidone given in the form of a long-acting depot injection. The data were collected by direct observation, analysis of the history of the disease and used semi-structured interview. Interviews completed by patients, psychiatrists and nurses were analyzed and condensed into nine key categories: Competence and training of the medical workers, Sites and technique, Registration of complications, Care of patients and privacy, Availability and evidence, Duration and frequency of treatment, Burden for the patients, The choice of formulation therapy, and Sense of stigma. Monitoring of side-effects of LAIs was not extensive and doctors did not write adverse effects. The nurses who administered the injections were competent. Not enough attention is paid to the choice of the needle diameter and the patient was not given a choice to decide on the sites of the administraton of injection. Three out of five patients did not feel any changes at the injection site, but another patient had severe pain, redness, and induration. The exchange of information, a possibility of choosing the site of administration, and monitoring of the effects of treatment are all positive strategies that doctors and nurses can use to help patients in the compliance to the treatment with antipsychotic long-acting injections.

Summary Delirium is a common complication in hospitalized elderly patients suffering from hip fractures. Considering the growing incidence of delirium, understanding the risk factors for this condition is of great importance. The preoperative prevalence of delirium is approximately 4.4–35.6%, while postoperative prevalence is even higher - 4–53.3%. Various studies have shown the multifactorial etiology of delirium arising from a combination of predisposing and precipitating factors. The aim of this study was to explore these factors, which can contribute to delirium in patients with femoral neck fractures. This case control study included 62 patients diagnosed with femoral neck fractures, with 31 cases and 31 controls. Results have shown that the use of sedatives, especially benzodiazepines, and smoking increase the risk of delirium by five and sixteen times, respectively.

Abstract Non-pharmacological treatment including diet, body weight reduction, smoking cessation and physical activity, is very important part of hypertension treatment. The objective of this study was to investigate the adherence to healthy lifestyle behavior in the representative sample of the older hypertensive patients, and to investigate factors associated with adherence in the studied older population. The study was conducted on random sample of 362 long term hypertensive (> five years) patients older than 65 years of age, at Health Care Center of Kragujevac. Adherence was assessed using the structured questionnaire for the analysis of the implementation of both hypertension and diabetes guidelines in the primary care. Both bivariate and multivariate analyses were conducted. Nearly 35% of examined patients were highly adherent; they exercised regularly, avoided smoking for at least five years and consumed special healthy diet prescribed for hypertension. Another 35.6% of the cases reported exercising regularly, 39.5% followed the recommended diet for the hypertension, while 23.4% of the patients have still consumed cigarettes. Multivariate logistic regression demonstrated that received counseling on healthy lifestyle behaviors by physicians and lack of education predicted high adherence to healthy lifestyle behavior. In order to improve adherence of elderly hypertensive patients to healthy lifestyle, strengthening patient-physician relationships through efforts to enhance communication may be a promising strategy to enhance patients’ engagement in healthy lifestyle behaviors for hypertension. Such an improvement could be achieved through the education of both the physicians and patients.

Abstract Radiotherapy is a frequently prescribed and highly effective form of treatment of oncology patients. However, many patients feel rational or irrational fear of the application of radiotherapy, which may provoke mental and physical stress, anxiety, growing anger and hostility, thus reducing quality of life. The aim of this study was to develop, reliability test and validate a questionnaire for assessing the level of fear of radiotherapy in oncology patients. We performed a prospective qualitative study based on the development, validation and reliability testing of the questionnaire developed for assessing radiotherapy-caused fear in oncology patients treated in the Centre for Oncology and Radiology, Department of Radiotherapy, Clinical Centre Kragujevac. The study included 154 patients and the final version of the questionnaire integrated 15 questions. After the elimination of inappropriate questions the Cronbach coefficient α was 0.946. The questionnaire consists of two factors which represent 57.423% and 6.925%, making a total of 64.348% of the variance of the questionnaire. The results of our study show that the questionnaire used is a unique, reliable and valid instrument for assessing the level of fear of radiotherapy in oncology patients the application of which will allow us to identify patients with elevated levels of fear of radiotherapy.

Introduction: Quality of life in patients with acute pharyngitis or tonsillitis is significantly lower than in healthy persons, and it should be taken into account when efficacy of new therapeutic options is investigated. Objective: The aim of this study was to develop and validate a reliable instrument that can measure quality of life in adult outpatients with sore throat caused by acute pharyngitis or acute tonsillitis. Method: The study was of a cross-sectional type, and assessed reliability and validity of newly developed questionnaire for measurement of quality of life in adult outpatients with sore throat (STQoL) caused by acute pharyngitis or acute tonsillitis. It was conducted on a sample of 282 patients, with mean age 39.0 ± 14.8 years, male/female ratio 104/178 (36.9%/63.1%). Results: Final version of the STQoL scale with 21 items showed excellent reliability, with Cronbach’s alpha 0.949. It was temporally stable, and both divergent and convergent validity tests had good results. Factorial analysis revealed three domains, Social/psychic aspects, Physical aspects and Environmental aspects of sore throat related quality of life. Conclusions: The STQoL scale is reliable and valid specific instrument for measuring sore throat related quality of life, which is an important treatment outcome in patients with acute pharyngitis or tonsillitis.