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Gaebel W, Lehmann I, Chisholm D, Hinkov H, Höschl C, Kapócs G, Kurimay T, Tosevski DL, Milosavljevic M, Nakov V, Winkler P, Zielasek J. Quality indicators for mental healthcare in the Danube region: results from a pilot feasibility study. Eur Arch Psychiatry Clin Neurosci 2021; 271:1017-1025. [PMID: 32270290 DOI: 10.1007/s00406-020-01124-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 03/30/2020] [Indexed: 10/24/2022]
Abstract
Quality indicators are vital for monitoring the transformation of institution-based mental health services towards the provision of person-centered mental healthcare. While several mental healthcare quality indicators have been identified as relevant and valid, their actual usability and utility for routine monitoring healthcare quality over time is significantly determined by the availability and trustworthiness of the underlying data. In this feasibility study, quality indicators that have been systematically identified for use in the Danube region countries of Bulgaria, the Czech Republic, Hungary, and Serbia were measured on the basis of existing mental healthcare data in the four countries. Data were collected retrospectively by means of the best available, most standardized, trustworthy, and up-to-date data in each country. Out of 21 proposed quality indicators, 18 could be measured in Hungary, 17 could be measured in Bulgaria and in the Czech Republic, and 8 could be measured in Serbia. The results demonstrate that a majority of quality indicators can be measured in most of the countries by means of already existing data, thereby demonstrating the feasibility of quality measurement and regular quality monitoring. However, data availability and usability are scattered across countries and care sectors, which leads to variations in the quality of the quality indicators themselves. Making the planning and outputs of national mental healthcare reforms more transparent and evidence-based requires (trans-)national standardization of healthcare quality data, their routine availability and standardized assessment, and the regular reporting of quality indicators.
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Affiliation(s)
- Wolfgang Gaebel
- Department of Psychiatry and Psychotherapy, Medical Faculty, LVR-Klinikum Düsseldorf, Heinrich-Heine-University, Bergische Landstraße 2, 40629, Düsseldorf, Germany. .,WHO Collaborating Centre on Quality Assurance and Empowerment in Mental Health, Düsseldorf, Germany.
| | - I Lehmann
- LVR-Institute for Healthcare Research, Cologne, Germany
| | - D Chisholm
- WHO Regional Office for Europe, Copenhagen, Denmark
| | - H Hinkov
- NCPHA-National Center of Public Health and Analyses, Sofia, Bulgaria
| | - C Höschl
- National Institute of Mental Health, Klecany, Czech Republic
| | - G Kapócs
- Department of Psychiatry and Psychiatric Rehabilitation, Buda Family Centred Mental Health Centre, Teaching Department of Semmelweis University, Saint John Hospital, Budapest, Hungary.,Institute for Behavioral Sciences, Semmelweis University, Budapest, Hungary
| | - T Kurimay
- Department of Psychiatry and Psychiatric Rehabilitation, Buda Family Centred Mental Health Centre, Teaching Department of Semmelweis University, Saint John Hospital, Budapest, Hungary.,Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
| | | | - M Milosavljevic
- Institute of Mental Health, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - V Nakov
- Mental Health, National Center of Mental Health and Analyses, Sofia, Bulgaria
| | - P Winkler
- Department of Social Psychiatry, National Institute of Mental Health, Klecany, Czech Republic
| | - J Zielasek
- LVR-Institute for Healthcare Research, Cologne, Germany
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Nakov R, Lyutakov I, Mitkova A, Gerova V, Petkova V, Giragosyan S, Vatcheva-Dobrevska R, Kaneva R, Nakov V. Establishment of the first stool bank in an Eastern European country and the first series of successful fecal microbiota transplantations in Bulgaria. Eur Rev Med Pharmacol Sci 2021; 25:390-396. [PMID: 33506928 DOI: 10.26355/eurrev_202101_24406] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE For safe implementation and broader application of fecal microbiota transplantation (FMT), quality controlled stool banking is a must. Establishing a stool bank is a complex, time-consuming, and expensive process, making it a real challenge in an Eastern European country. We aimed to establish the first stool bank in Eastern Europe - in Bulgaria. SUBJECTS AND METHODS A multidisciplinary team of gastroenterologists, microbiologists, infectionists, and geneticists was set up. We used a questionnaire based on the First European FMT Consensus in order to recruit possible stool donors. Laboratory blood and stool tests were performed on all potential donors. RESULTS Between October 2018 and April 2019, 112 donor volunteers completed a questionnaire; 70 (62.5%) were excluded, mainly because of age above 50, an unhealthy BMI, and risk behavior. Fourty-two (37.5%) donor candidates were invited for laboratory testing of blood and feces, of which 12 (28.6%) passed this screening. Of 12 donors, 4 (33%) failed at the following screening test, which is performed every 3-6 months. Finally, 8 (7.14%) active donors were enrolled. Ten successful FMTs were performed on patients with recurrent Clostridium difficile infection. CONCLUSIONS Even though we found many healthy volunteers, only a low percentage (7.14%) of them were suitable to become feces donors. Establishing a stool bank in an Eastern European country is essential for making FMT safe and more popular as a treatment method, finding further implementation and regulation of FMT and supporting physicians offering this treatment to their patients.
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Affiliation(s)
- R Nakov
- Clinic of Gastroenterology, Tsaritsa Yoanna University Hospital, Medical University of Sofia, Sofia, Bulgaria.
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Nakov V. Changing the system of psychiatric care in bulgaria. Recover-E project in bulgaria. Eur Psychiatry 2021. [PMCID: PMC9471409 DOI: 10.1192/j.eurpsy.2021.201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Bulgaria has undergone a number of very significant political and social changes over the past 150 years that has also impacted on the delivery of mental health care. There has been a 40% reduction in the number of inpatient psychiatric beds in Bulgaria within the past 20 years leading to the current state of approximately European average bed numbers per 100 000 population. This does not appear to have been accompanied by an increased investment in ambulatory / outpatient mental health services. Objectives Description of the advantages and disadvantages of mental health services in Bulgaria, available staff and distribution in the country. The project RECOVER-E and its activities in Bulgaria are described. Methods Sources of health statistics of Bulgaria are used and analyzed. Maps and tables were used for visualization. Results Taking into account the situation described in this way and the EPA guidelines for change in the system, a mental health strategy has been proposed. Conclusions It has a long and significant legacy of underfunding of mental health services, which has undoubtedly caused significant economic damage to Bulgaria through surmountable results increasing health and social care costs, and surmountable loss of economic productivity. A significant increase in the budget allocated to mental health and related social care services. Disclosure No significant relationships.
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Nakov R, Velikova T, Nakov V, Ianiro G, Gerova V, Tankova L. Serum trefoil factor 3 predicts disease activity in patients with ulcerative colitis. Eur Rev Med Pharmacol Sci 2020; 23:788-794. [PMID: 30720187 DOI: 10.26355/eurrev_201901_16893] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE In this study, we aimed to evaluate the role of serum trefoil factor 3 (TFF3) as a biomarker of disease activity in patients with inflammatory bowel disease (IBD) and to compare TFF3 values with those of fecal calprotectin (FC). PATIENTS AND METHODS 128 patients with IBD were divided into four groups: 1) active ulcerative colitis (UC); 2) quiescent UC; 3) active Crohn's disease (CD); 4) quiescent CD. The serum levels of TFF3 and FC levels were assessed in all patients and 16 controls. RESULTS Patients with active UC had higher TFF3 levels than those with quiescent UC (p<0.001), those with active (p<0.001) or quiescent CD (p<0.001) and controls (p <0.001). We found a correlation between TFF3 and FC values in patients with active (r = 0.478, p = 0.006) and quiescent UC (r=0.528, p=0.002). TFF3 levels correlated with endoscopic activity in UC (evaluated by UC Endoscopic Index of Severity - UCEIS) (r=0.662, p<0.001). CONCLUSIONS Serum TFF3 is able to identify patients with active UC. It could be used as a marker to predict disease activity in patients with UC.
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Affiliation(s)
- R Nakov
- Clinic of Gastroenterology, "Tsaritsa Yoanna - ISUL" University Hospital, Medical University of Sofia, Sofia, Bulgaria.
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Tankova L, Nakov R, Stoilov G, Gegova A, Nakov V, Gerova V, Terziev I, Kovatchki D. Endorectal power Doppler ultrasonography is a reliable method for evaluation of rectal cancer angiogenesis. Eur Rev Med Pharmacol Sci 2019; 23:1661-1667. [PMID: 30840290 DOI: 10.26355/eurrev_201902_17127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE We aimed to assess the preoperative rectal cancer angiogenesis with Endorectal Power Doppler Ultrasonography by using the Power Doppler Vascularity Index (PDVI) calculated by imaging analysis software, and to compare it with the microvessel density (MVD) in surgical specimens PATIENTS AND METHODS: This study included 110 patients (39 females; mean age 61.5 years) with rectal cancer. Immunohistochemical staining of surgical specimens with anti-CD-31 antibody was used for MVD evaluation. The PDVI of each tumor was calculated using Endorectal Power Doppler with computer-assisted quantification of colour pixels. RESULTS Mean MVD - 163 ± 69 microvessels/mm2 (50-328) was used as a cutoff point, differentiating two groups of tumors with high (> 160 mm2) and low (≤ 160 mm2) angiogenic activity. Mean PDVI of 8.9 ± 6.0% (0-27.3) was used as a cutoff point, dividing two groups of tumors with high (> 8%) and low (≤ 8%) PDVI. The MVD and the PDVI showed a good positive correlation (r = 0.438, p = 0.002). Patients with low PDVI had 25 months longer overall survival (p < 0.05) than patients with high PDVI. Patients with low MVD had 36 months longer survival (p < 0.05). CONCLUSIONS Endorectal Power Doppler Ultrasonography is a reliable and noninvasive method for assessment of the extent of rectal cancer angiogenesis. Tumor angiogenesis assessed by the PDVI correlated with histological MVD determination and could predict survival rates. Endorectal Power Doppler examination is a useful and reproducible method for in vivo preoperative quantitative assessment of tumor vascularization.
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Affiliation(s)
- L Tankova
- Clinic of Gastroenterology, "Tsaritsa Yoanna" Hospital, Medical University Sofia, Sofia, Bulgaria.
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Stoychev K, Nakov V, Dekov D, Baltov M, Dinolova-Hodzhadzhikova R, Ivanov K, Stoimenova M, Chumpalova P. Comparative analysis of suicidality in two Bulgarian regions. Eur Psychiatry 2017. [DOI: 10.1016/j.eurpsy.2017.02.476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
IntroductionSuicidality is still an understudied problem in Bulgaria especially on a subnational (regional) level.ObjectivesTo collect data on suicidality in two major regions of Bulgaria with a population over 250,000 each (Plovdiv and Pleven) for a six years period (2009–2015).AimsTo analyze demographic, health-related and other characteristics associated with suicidal behavior as well as motives and methods of suicide.MethodsData were extracted from relevant documentation (medical records, public health reports, etc.) and statistically processed upon collection.ResultsMajority of suicide victims were males between 45 and 64 years while most suicide attempts occurred among 18–29 years old females.Leading method of suicide was hanging, followed by jumping from high places and use of firearm.Prevailing suicidal motives were psychotic symptoms, serious somatic illnesses and family problems. Depression accounted for 25% of all suicide cases and in another 25% motivation could not be identified because of insufficient data.The proportion of unemployed among suicide committers was not significantly higher than that of employed and retired.ConclusionsSevere mental disorders are a major trigger of suicidal behavior.Personal relationships should be targeted by suicide prevention interventions.Somatic illnesses are increasingly important suicide risk factor driven by the ongoing process of population aging.Frontline healthcare professionals should be trained to explore underlying suicidal motives and actively probe for depression in each case of suicidal behavior.Unemployment related suicide risk is most likely mediated through an adaptation crisis mechanism induced by the abrupt change of social status.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Todorov I, Nakov V, Eftimov T, Simeonov P, Stavrev E, Ninov K. Conventional versus Ultrasound Neuronavigation in the Surgery of Cerebral Metastases. J Neurol Surg A Cent Eur Neurosurg 2015. [DOI: 10.1055/s-0035-1566409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Nakov V, Ninov K, Todorov I, Simeonov P, Stavrev E, Eftimov T. Two Cases of Rare Schwannomas of the Vagal Nerve. J Neurol Surg A Cent Eur Neurosurg 2015. [DOI: 10.1055/s-0035-1566395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Nakov V, Lilov M, Eftimov T, Todorov I, Ninov K. Saccular Aneurysms of the Vertebrobasilar System - Endovascular versus Surgical Treatment. J Neurol Surg A Cent Eur Neurosurg 2014. [DOI: 10.1055/s-0034-1382240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Todorov I, Eftimov T, Hadzhiangelov I, Nakov V, Simeonov P, Stavrev E, Ninov K, Romansky K, Enchev Y. Classic Versus Ultrasound Navigation in the Surgery of High Grade Gliomas. J Neurol Surg A Cent Eur Neurosurg 2014. [DOI: 10.1055/s-0034-1382210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Nakov V, Eftimov T, Ninov K, Todorov I. Vascular Complications Following the Surgical Treatment of Ruptured Intracranial Aneurysms. J Neurol Surg A Cent Eur Neurosurg 2014. [DOI: 10.1055/s-0034-1382241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Lilov M, Eftimov T, Nakov V, Todorov I, Ninov K. Assisted Endovascular Coiling of Wide Neck Aneurysms - Double Microcatheter and JAIL Techniques. J Neurol Surg A Cent Eur Neurosurg 2014. [DOI: 10.1055/s-0034-1382238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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