Faculty of Medicine

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Mental health in Central and Eastern Europe: a comprehensive analysis
(Elsevier BV, 2025-10)
Winkler, Petr
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Guerrero, Zoe
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Kågström, Anna
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Petrášová, Michaela
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Pashoja, Arlinda Cerga
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Transition Towards Transradial Approach Improves Outcomes of Acute Myocardial Infarction PCI
(Macedonian Academy of Sciences and Arts/Walter de Gruyter GmbH, 2017-09-01)
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Antov, Slobodan
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Kalpak, Gjorgji
Introduction and aim: Transradial (TRA) instead of transfemoral (TFA) approach strategy has been presented in research literature as superior access strategy especially for acute ST elevation myocardial infarction (STEMI) primary percutaneous coronary intervention (PCI). There is a paucity of registry-based data of outcomes from default TRA strategy compared to TFA. Materials and methods: All-comers STEMI PCI institutional Registry identified 1808 consecutive patients in time-frame of 40 months from 2007 to 2010, without making any exclusions. Moreover, we applied Propensity Score Matching (PSM) to replace randomization, address the potential confounding and selection bias. PSM derived 565 congruent pairs of patients from the groups. Results: After 30 days the primary composite endpoint of major adverse cardiovascular events (MACE) was in favor of TRA 6.5% vs. 12.4% in TFA group, simultaneously secondary endpoints of death in TRA with rate of 4.8% and with rate of 10.1% in TFA. Moreover, the rate of major access related bleeding was 1.1% in TRA vs. 8.5% in TFA, in contrast the major non-access related bleeding was 1.8% and 2.4% respectively showed no significant difference. One year Kaplan Meier survival plots were in favor of TRA. Conclusions: Default transradial access strategy is associated with improved STEMI PCI outcomes.
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Community mental healthcare
(Ovid Technologies (Wolters Kluwer Health), 2020-06-30)
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Kalpak, Gjorgji
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Jovanovic, Nikolina
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Community mental healthcare: new developments and innovative strategies
(2020-09)
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Kalpak, Gjorgji
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Jovanovic, Nikolina
The aim of this scoping review was to identify and map the available evidence on recent innovations in community mental healthcare across the globe.
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Patient Satisfaction with Use of Telemedicine in University Clinic of Psychiatry: Skopje, North Macedonia During COVID-19 Pandemic
(Mary Ann Liebert Inc, 2021-04)
Haxhihamza, Kadri
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Kalpak, Gjorgji
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Background: There is increasing interest in the use of telemedicine as a means of health care delivery especially in circumstances of pandemics. This is partly because technological advances have made the equipment less expensive and simpler to use and partly because increasing health care costs and patient expectations have increased the need to find alternative modes of health care delivery. Introduction: Telemedicine and telepsychiatry, in particular, are rapidly becoming important delivery approaches to providing clinical care and information to patients in cases wherein the medical resources and the patients are very hard to be brought together with respect to rules of behavior in case of epidemics. The reliance on technology to bridge the obstacles between the patients (consumers) and medical resources (providers) can create problems that impact service delivery and outcomes, but in cases such as this (COVID-19 pandemics), this is virtually the only tool for providing clinical care and information to patients. Materials and Methods: A client satisfaction survey was undertaken in a daily hospital (a part of University Clinic of Psychiatry in Skopje). The anonymous modified self-report questionnaire (short form patient satisfaction questionnaire [PSQ-18]) covering demographic, gender, and age variables was endorsed by 28 participants. The mean age of the subjects was 40.25 ± 22 years, with a small majority of men (18 participants) versus women (11 participants). Results: Overall satisfaction with psychiatric care was high (80.22%). None of the demographic or other variables correlated significantly with satisfaction. Discussion: We had to reduce rate and time length of our face-to-face contacts with patients as a result of pandemics but they were able to reach their doctors virtually at all times. Conclusions: Many mental health professionals are using widely available, commercial software downloaded from the internet to provide care directly to a patient's home.
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Depression and Anxiety in Adolescents and their Caregivers: A Cross-Sectional Study from North Macedonia
(Македонска академија на науките и уметностите, Одделение за медицински науки = Macedonian Academy of Sciences and Arts, Section of Medical Sciences/Walter de Gruyter GmbH/Walter de Gruyter GmbH, 2023-03-01)
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Kunovski, Ivo
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Bolinski, Felix
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Introduction: Mental health problems have increased internationally during the COVID-19 pandemic. Adolescents and their caregivers form a vulnerable group for the development of mental health problems. However, most data stems from high-income countries, and there is a clear lack of prevalence rates and potential risk factors from Balkan countries. No data is available on the impact of the COVID-19 pandemic on mental health in adolescents and their caregivers in North Macedonia. Materials and methods: A cross-sectional study was conducted on adolescents and their caregivers in a school setting in rural and urban areas of North Macedonia. Survey items assessed symptoms of depression, anxiety, and respondents' fear of COVID-19, as well as a number of risk factors, such as gender and living environment. Results: 506 adolescents and 492 caregivers completed the survey. Symptoms of depression and anxiety were mild to moderate in adolescents and their caregivers. Women and girls generally scored higher than men and boys, and adolescents in high school scored higher than those in elementary school. Prevalence rates for depression were 29.2% for adolescents and 10.4% for caregivers, while rates of anxiety were 23.7% for adolescents and 6.1% for caregivers. Conclusion: This study provides a first insight into the mental health of adolescents and their caregivers after the COVID-19 pandemic in North Macedonia. Further research is required to investigate the relatively low rates of caregivers' mental health problems compared to data from other countries.
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Crossover Alternatives of Default Right Radial Artery Access for Acute Myocardial Infarction Intervention
(Macedonian Medical Association/ Walter de Gruyter GmbH, 2017-01-01)
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Kalpak, Gjorgji
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Jovanoska, Marija
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Abstract. Introduction.Being a default transradial access center we have encountered the need for alternative to the right radial artery. Determining the most frequent alternative access strategy for PCI in STEMI patientswasthe focus of our study. We sought to analyze whether the wrist access strategy impacts procedure time and success rate particularly for the STEMI interventions where time is of paramount importance.</jats:p> <jats:p><jats:bold>Methods.</jats:bold> During four years, in our Center 2624 consecutive all-comers STEMI patients underwent urgent coronary intervention. TRA was used as the first-choice access strategy. We sought to assess crossover rate and safety of preferable access strategy. Crossover occurred according to the operator's decision. Primary outcomes were: access site crossover rate and In Lab time, secondary outcomes were PCI time, X-ray time, mortality and MACE at 30 days and at 6 months.</jats:p> <jats:p><jats:bold>Results.</jats:bold> Overall crossover rate from default radial was 5.4% (144 out of 2624 patients). We treated 98.7% (2589) patients by wrist access and only 1.3% (35) patients with TFA. Crossover towards left radial occurred in 47.9% (69 out of 144 patients), towards ulnar 27.8% (40 patients) and towards TFA only 24.3% (35 patients). The meanIn-Lab time 40.4±17.7 minutes, PCI time was 21.4±7.4 min, X-ray time 9.2±4.7 minutes. Survival outcomes at 30 days were: MACE rate of 6.6% (174 patients), mortality rate of 5.0% (131 patients). At six months MACE rate was 8.6% and mortality rate was 5.6%.</jats:p> <jats:p><jats:bold>Conclusions.</jats:bold> Default radial access is associated with alow crossover rate. Crossover towards femoral occurred less frequent than ulnar artery access.Complete wrist access strategy is safe and feasible for STEMI interventions with low mortality and MACE rate in unselected all-comers cohort.</jats:p>

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