Medical informatics--today and tomorrow

The status of medical informatics, a comparatively new biomedical discipline beginning to develop in the second half of the 20th century, is described at the transition into the 21st century. The appearance of new information and communication technologies, among which Internet nas special importance, was a major impulse to the development of medical informatics in its different fields. Health information systems are integrating, while at the same time, by distribution of their parts, they become available to the individual healthcare user. These processes put the problems of interoperability and standardization into the focus of contemporary medical informatics. The electronic health record is recognized as a key instrument of modern healthcare systems, and its development and implementation are being planned at many places. Whereas the research and application of medical decision support systems are stagnating, new disciplines have emerged such as telemedicine, cybermedicine and bioinformatics. The perspectives of the future development of medical informatics are described. In the appendix, a chronology of the development of medical informatics from its beginning to the present time is given.     

Cancer immunotherapy: Yesterday and tomorrow

A great deal has been said and written about the development of our capacity to treat cancer by immunization or to immunize against cancer. But this is far from being available in the immediate future. This is why we believe it is important to place immunotherapy in its historical context, to understand its specific role and to state clearly what may be expected from it. Surgery is, whenever possible, the primary method of treating a patient with a surgically accessible tumor. Surgical removal should be as extended and careful as possible. Sometimes the mass of the tumor is such that it is necessary to reduce it by radiotherapy or chemotherapy prior to surgery.     

The bacteriology laboratory of tomorrow

The development of needs and the conditions for performing examinations in clinical bacteriology leads us to consider that bacteriological analysis should eventually: be closer to clinical requirements. This results in an accelerated bacteriology (whose response-times approach those of other biological specialties) and in a consideration of the diagnostic and therapeutic importance of the response; be less costly. This leads to an increase in productivity, and involves an introduction of computers, automatic systems for antibiograms and identification, and appropriate and inexpensive bioreagents; consider the requirements of the technicians in order to avoid diminishing the interest of the work. This development demands a recognition of needs, whether expressed or not, and a rejection of olds habits that are not adapted to the requirements of a bacteriology which is closer to the patient, quicker, and finally, less costly.     

Private contracted primary health physician: today and tomorrow

Contracted primary health physician is the cornerstone of health care system. He is the main provider of all contracted obligations. It is necessary to evaluate the role of other contributors and organizational forms. Not the practice ownership but contract with the Croatian Institute of Health Insurance is fundamental for the status of general practitioners. Primary care should be based on Group Practice and Primary Health Trusts.     

Epitope-vaccine strategy against HIV-1: today and tomorrow

Vaccines play important roles in preventing infectious diseases caused by different pathogens. However, some pathogens such as HIV-1 challenge current vaccine strategy. Poor immunogenicity and the high mutation rate of HIV-1 make great difficulties in inducing potent immune responses strong enough to prevent infection via vaccination. Epitope-vaccine, which could intensively enhance predefined epitope-specific immune responses, was suggested as a new strategy against HIV-1 and HIV-1 mutation. Epitope-vaccines afford powerful approaches to elicit potent, broad and complete immune protection against not only primary homologous viral isolates but also heterologous viral mutants. Although most studies are still preliminary now, epitope-vaccine as a novel strategy against the AIDS epidemic has great developmental potential. To trigger T-cell-dependent IgG antibody responses and improve affinities of the epitope-specific antibodies, approaches such as recombinant multi-epitope-vaccination and prime-boosting vaccination were suggested. Cellular immune responses, especially CTL responses, could also be elicited and enhanced in addition to humoral immune responses. Developed epitope-vaccines activating both arms of the immune system would benefit prevention and immunotherapy not only against HIV but also other chronic infections.