Processes of nursing care in a patient with third and fourth degree burns

Svako oštećenje kože predstavlja potencijalnu prijetnju zdravlju organizma. Među najtežim ozljedama kože su opekline, koje mogu nastati uslijed izlaganja visokim temperaturama, električnoj energiji, radijaciji ili kemijskim tvarima. Opekline uzrokuju lokalne i sistematske promjene u tijelu te se klasificiraju prema ozbiljnosti i veličini zahvaćene površine tijela, često koristeći Wallaceovo pravilo devetke za procjenu opsega. Zbog svoje kompleksnosti, liječenje opekotina zahtijeva suradnju različitih medicinskih stručnjaka i dugotrajnu skrb, što može predstavljati veliki financijski izazov za zdravstveni sustav i predstavlja važan problem za javno zdravstvo. Njega pacijenata s opeklinama je zahtjevna i dinamična, a medicinska sestra igra ključnu ulogu u svim aspektima njihove skrbi. Ovaj rad fokusira se na identifikaciju prioritetnih problema pacijenata s opeklinama, što medicinska sestra čini na temelju svojeg znanja, iskustva i stručnosti u procesu pružanja zdravstvene njege. Osim osnovne medicinske skrbi, pacijentima s opeklinama treba pružiti i emocionalnu podršku, te podršku u socijalnom i rehabilitacijskom kontekstu. Medicinska sestra analizira osnovne ljudske potrebe pacijenta kako bi identificirala prioritetne sestrinske dijagnoze, koje će služiti kao smjernice za pružanje usmjerenih aktivnosti za pacijenta. Pravilno provedene njege opekotina doprinose boljem ishodu i tijeku liječenja pacijenata s opeklinama.Any damage to the skin represents a potential threat to the health of the organism. Among the most severe skin injuries are burns, which can occur due to exposure to high temperatures, electrical energy, radiation, or chemical substances. Burns cause both local and systemic changes in the body and are classified based on the severity and the size of the affected body surface, often using Wallace's rule of nines to assess the extent. Due to its complexity, the treatment of burns requires the collaboration of different medical experts and long-term care, which can pose a significant financial challenge to the healthcare system and is an important public health issue. The care of burn patients is demanding and dynamic, and nurses play a crucial role in all aspects of their care. This paper focuses on identifying the priority issues of burn patients, which nurses do based on their knowledge, experience, and expertise in the process of providing healthcare. In addition to basic medical care, burn patients need emotional support, as well as support in a social and rehabilitation context. Nurses analyse the basic human needs of the patient to identify priority nursing diagnoses, which will serve as guidelines for providing targeted activities for the patient. Properly performed burn care contributes to better outcomes and the course of treatment for patients with burns. Keywords: burn, skin and nursing car

American approach to healthcare financing

Zdravstveni sustav Sjedinjenih Država ima značajne prednosti i značajne slabosti. Ima veliku i dobro obučenu zdravstvenu radnu snagu, širok raspon visokokvalitetnih medicinskih stručnjaka, kao i sekundarnih i tercijarnih ustanova, snažan istraživački program zdravstvenog sektora i, za odabrane usluge, među najboljim medicinskim rezultatima u svijetu. Ali također pati od nepotpune pokrivenosti svog stanovništva, razina izdataka za zdravstvo po osobi koje daleko premašuju sve druge zemlje, loših mjera mnogih objektivnih i subjektivnih mjera kvalitete i ishoda, nejednake distribucije resursa i ishoda u cijeloj zemlji i među različitim skupinama stanovništva. Teško je odrediti u kojoj su mjeri nedostaci povezani sa zdravstvenim sustavom, iako se čini da su barem neki od problema posljedica lošeg pristupa skrbi. Zbog usvajanja Affordable Care Act (ACA) 2010. godine, Sjedinjene Države suočavaju se s razdobljem golemih potencijalnih promjena. Poboljšanje pokrivenosti središnji je cilj, predviđeno kroz subvencije za neosigurane osobe za kupnju privatnog osiguranja, proširenu podobnost za Medicaid ( u nekim državama) i veću zaštitu osiguranika. Nadalje, primarna zdravstvena zaštita i javno zdravstvo dobivaju veća sredstva, a kvalitetom i izdacima rješava se niz mjera. Hoće li ACA doista biti učinkovita u rješavanju gore navedenih izazova može se odrediti tek s vremenom. Američki zdravstveni sustav često se naziva skupim i neučinkovitim nesustavom. Postoje mnogi dionici i pružatelji usluga, visoki troškovi i lošiji zdravstveni rezultati stanovništva od onih postignutih u drugim industrijaliziranim zemljama kao što su Britanija, Njemačka i Kanada. Zdravstveni sustav je rasprostranjen s visokim razinama pokrivenosti za različite planove osiguranja kroz osiguranje temeljeno na zapošljavanju zajedno s javno financiranim i upravljanim zdravstvenim osiguranjem. Rješavanje najzahtjevnijih pitanja financiranja, isporuke i politike zdravstvene skrbi ovisi koliko o pronalaženju zajedničkog jezika toliko i o medicinskim, društvenim, bihevioralnim i organizacijskim znanostima.The United States health care system has significant strengths and significant weaknesses. It has a large and well-trained healthcare workforce, a wide range of high-quality medical professionals as well as secondary and tertiary facilities, a strong health sector research program and, for selected services, among the best medical outcomes in the world. But it also suffers from incomplete coverage of its population, levels of health expenditure per person that far exceed all other countries, poor measures of many objective and subjective measures of quality and outcomes, unequal distribution of resources and outcomes across the country and among different population groups. It is difficult to determine the extent to which the deficiencies are related to the health care system, although at least some of the problems appear to be due to poor access to care. With the passage of the Affordable Care Act (ACA) in 2010, the United States is facing a period of enormous potential change. Improving coverage is a central goal, envisioned through subsidies for the uninsured to purchase private insurance, expanded Medicaid eligibility (in some states), and greater protections for the insured. Furthermore, primary health care and public health receive more funding, and quality and expenditure are addressed by a number of measures. Whether the ACA will actually be effective in addressing the above challenges can only be determined with time. The American health care system is often called an expensive and inefficient system. There are many stakeholders and service providers, high costs and poorer population health outcomes than those achieved in other industrialized countries such as Britain, Germany and Canada. The health care system is widespread with high levels of coverage for various insurance plans through employment-based insurance along with publicly funded and managed health insurance. Solving health care's most challenging financing, delivery, and policy issues depends as much on finding common ground as it does on the medical, social, behavioral, and organizational sciences

Identification of possible victims of abuse in the Eye Diseases Clinic and in the Department of Orthopedics and Traumatology of the Surgical Clinic of KBC Split; Attitudes and knowledge of nurses and physicians about abuse of women

Uvod: IPV je javnozdravstveni problem koji može dovesti do smrtnosti i obolijevanja. Žrtve IPV-a se učestalo javljaju u zdravstvene ustanove zbog traume oka ili traume mišićno-koštanog sustava kao posljedice IPV-a. Stoga je potrebno pomno ispitati važnost pravovremenog uočavanja i reagiranja medicinskih sestara i liječnika na pacijentice koje su žrtve nasilja od strane intimnog partnera kako bi se popunila trenutna praznina u ovom području. Cilj: Istražiti znanje i stavove medicinskih sestara i liječnika u vezi s nasiljem nad ženama na Klinici za očne bolesti i Zavodu za ortopediju i traumatologiju Klinike za kirurgiju KBC-a Split. Metode: Istraživanjem je obuhvaćeno 97 ispitanika u razdoblju od 1. listopada do 30. studenog 2023. godine. Svih 97 ispitanika su bili medicinske sestre i liječnici sa zasnovanim radnim odnosom u Klinici za očne bolesti i u Zavodu za ortopediju i traumatologiju Klinike za kirurgiju KBC-a Split koji su popunili upitnik “Nasilje nad ženama – Upitnik za pružatelje zdravstvenih usluga“. Rezultati: Eksploratornom faktorskom analizom, uz korištenje PCA sa svojstvenom vrijednošću većom od 1 uz Varimax rotaciju i uvjet da su apsolutne vrijednosti veće od 0,45, dobili smo 7 faktora koja objašnjavaju ukupno 65,14% varijance. Samo 3 medicinske sestre i 2 liječnika su educirani o zlostavljanju žena. Medicinske sestre su imale više iskustva s nasiljem nad ženama od liječnika (χ=5,7; p=0,17). Udio liječnika koji su pozvali policiju za 2,6 puta je veći nego udio medicinskih sestara koje su pozvale policiju (χ=3,9; p=0,047). Najviše ispitanika (11,3%) smatra kako je strah žene da verbalizira zlostavljanje najveća prepreka u probiru zlostavljanja žena. Na otvoreno pitanje što bi im pomoglo u olakšavanju probira 51,5% ispitanika nije dalo nikakav odgovor. Od ispitanika koji su odgovorili na pitanje, najviše ispitanika (22,7%), od toga 25,4% medicinskih sestara i 17,6% liječnika smatra kako bi edukacija olakšala probir zlostavljanja žena. Zaključci: Hrvatska verzija upitnika „Nasilje nad ženama – Upitnik za pružatelje zdravstvenih usluga“ od ukupno 20 pitanja pokazala je primjenjivu pouzdanost u mjerenju znanja i stavova medicinskih sestara i liječnika u bolničkom sustavu o zlostavljanju žena. Nema razlike u znanju i stavovima o nasilju nad ženama između medicinskih sestara i liječnika u Klinici za očne bolesti i Zavodu za ortopediju i traumatologiju KBC-a Split, osim u stavovima profesionalne podrške.Introduction: IPV is a public health problem that can lead to mortality and morbidity. Victims of violence against women often come to health care facilities for eye trauma or musculoskeletal trauma as a result of IPV. Therefore, the importance of timely recognition and response by nurses and physicians to patients who are victims of intimate partner violence needs to be carefully considered in order to address the current gap in this area. Aim: To study the knowledge and attitudes of nurses and physicians regarding violence against women in the Eye Diseases Clinic and the Orthopedics and Traumatology Department of the Surgical Clinic of KBC Split. Methods: The study included 97 respondents in the period from October 1 to November 30, 2023. All 97 respondents were nurses and physicians in permanent employment at the Eye Diseases Clinic and the Department of Orthopedics and Traumatology of the Surgical Clinic of KBC Split who completed the questionnaire "Violence against women - questionnaire for health care providers". Results: Using exploratory factor analysis (PCA) with an eigenvalue greater than 1 and varimax rotation, and the condition that absolute values are greater than 0.45, 7 factors were identified, explaining a total of 65.14% of the variance. Only 3 nurses and 2 physicians were educated about abuse of women. Nurses had more experience with violence against women than physicians (χ=5.7; p=0.17). The proportion of physicians who called the police was 2.6 times higher than the proportion of nurses who called the police (χ=3.9; p=0.047). Most respondents (11.3%) believe that women's fear of verbalizing mistreatment is the greatest barrier to screening for mistreatment of women. The majority of respondents (51.5%) did not answer the open-ended question about what would help them facilitate screening. Of the respondents who answered the question, most (22.7%), including 25.4% nurses and 17.6% physicians, felt that education would facilitate screening for abuse against women. Conclusions: The Croatian version of the "Violence Against Women Questionnaire for Health Care Providers, with a total of 20 questions, proved to be reliable in measuring the knowledge and attitudes of nurses and physicians in the hospital system regarding abuse of women. There are no differences in knowledge and attitudes about violence against women between nurses and doctors at the Eye Diseases Clinic and the Department of Orthopedics and Traumatology at KBC Split, except for attitudes about professional support

Psychological disturbances in post COVID 19 reconvalescents

U ovom radu dat je pregled recentne literature o psihološkim smetnjama bolesnika izazvanih infekcijom SARS-CoV-2. Post Covid 19 je stanje koje nastaje kod bolesnika koji su preboljeli infekciju izazvanu SARS-CoV-2. Nakon akutnog preboljenja infekcije zaostali su im trajni simptomi. Najčešći simptomi post Covid 19 su dispneja, dugotrajni kašalj, kronični umor, kognitivne smetnje, anksioznost i depresija. Zaostali simptomi kod bolesnika negativno utječu na njihovu kvalitetu života. Psihološki simptomi se liječe kombinacijom farmakološkim i ne farmakološkim tretmanom. Farmakološki tretman uključuje korištenje propisane medikamentozne terapije, a nefarmakološki metode odnose se na primjenu psihoterapijskih postupaka i metoda relaksacije. Postupak sestrinske psihološke njege uključuje razgovor s bolesnikom, motivaciju bolesnika za psihološko liječenje i rano prepoznavanje psiholoških smetnji u bolesnika i smanjenje anksioznosti vezano uz post Covid smetnje. Jedna od učinkovitijih metoda je on-line razgovor sestre s bolesnikom.This paper provides an overview of recent literature on psychological disorders ofpatients caused by SARS-CoV-2 infection. Post-Covid 19 is a condition that occurs in patients who have recovered from an infection caused by SARS-CoV-2. After getting over the acute infection, they were left with permanent symptoms. The most common post-Covid 19 symptoms are dyspnea, prolonged cough, chronic fatigue, cognitive impairment, anxiety and depression. Residual symptoms in patients negatively affect their quality of life.Psychological symptoms are treated with a combination of pharmacological and non-pharmacological treatment. Pharmacological treatment includes the use of prescribed medicinal therapy, and non-pharmacological methods refer to the application of psychotherapeutic procedures and relaxation methods. The process of nursing psychological care includes a conversation with the patient, motivation of the patient for psychological treatment and early recognition of psychological disorders in the patient and reduction of anxiety related to post-Covid disorders. One of the more effective methods is an online conversation between a nurse and a patien

CRITICAL APPRAISAL OF HEALTH CLAIMS AMONG NURSING STUDENTS

SAŽETAK Cilj rada: Utvrditi sposobnost studenata sestrinstva da kritički procjene zdravstvene tvrdnje. Ispitanici i metode: Uzorak ispitanika u ovom istraživanju sačinjavali su studenti Sveučilišnog odjela zdravstvenih studija, smjer sestrinstvo. Ukupan broj studenta sestrinstva koji su sudjelovali u ovom istraživanju je 180, od čega 106 redovnih studenta preddiplomskog studija sestrinstva, 51 izvanredni student preddiplomskog studija sestrinstva te 23 studenta diplomskog studija sestrinstva. Ispitanici su dobrovoljno i anonimno popunili validirani test na hrvatskom jeziku koji, kao mjerni instrument, ima dobre metrijske karakteristike. Test se sastoji iz dva dijela od kojih prvi dio sačinjavaju demografska obilježja, dok se drugi dio odnosi na 18 scenarija (pričica) o zdravstvenim tvrdnjama te višestrukim ponuđenim odgovorima koji traže kritičku procjenu zdravstvenih tvrdnji. Rezultati: Ukupna riješenost testa svih ispitanika iznosi nešto više od 70%. Muškarci su bolje riješili test za oko 8% u odnosu na žene, a najmlađi studenti, oni s manje od 25 godina, bolje su riješili test od ostale dvije skupine za oko 4%. Studenti preddiplomskog i diplomskog studija sestrinstva bili su uspješniji od svojih kolega na izvanrednom studiju. Utvrđena je statistički značajna razlika između studenata koji su završili srednju zdravstvenu školu u odnosu na kolege koji su završili gimnaziju i to na razini p=0,031, gdje su studenti iz zdravstvene škole bili manje uspješni u riješenosti testa. Nadalje, utvrđena je statistički značajna razlika između studenata koji imaju i onih koji nemaju licencu zdravstvenog radnika, i to na razini značajnosti p=0,044. Studenti u skupini s najmanje radnog staža, bolje su riješili test od svojih kolega koji imaju više radnog staža za oko 3%. Zaključak: Studenti sestrinstva Sveučilišnog odjela zdravstvenih studija pokazali su dobru sposobnost kritičke procjene zdravstvenih tvrdnji. U sposobnosti kritičke procjene zdravstvenih tvrdnji nije utvrđena statistički značajna razlika po spolu i dobi studenata. Isto tako, nije utvrđena statistički značajna razlika prema duljini radnog staža. Postoji značajna razlika između studenata sestrinstva s licencom zdravstvenog radnika i onih koji nemaju licencu u sposobnosti kritičke procjene zdravstvenih tvrdnji. Isto tako, studenti koji su završili gimnazijski program imaju bolju sposobnost kritičke procjene zdravstvenih tvrdnji od studenata koji su završili srednju zdravstvenu školu.SUMMARY Aim of the paper: To determine the ability of nursing students to critically assess health claims. Methods: The sample of respondents in this study consisted of students from the University of Split Department of Health Studies, majoring in nursing. The total number of nursing students who participated in this research is 180, of which 106 are full-time undergraduate nursing students, 51 part-time undergraduate nursing students and 23 graduate nursing students. The respondents voluntarily and anonymously filled out a validated test in the Croatian language (Aranza et al.) which, as an instrument, has good metric characteristics. The test consists two parts, the first part consists of demographic characteristics, while the second part refers to 18 scenarios (stories) about health claims and multiple answers that require a critical assessment of health claims. Results: The percentage of correct responses on the test of all respondents is slightly more than 70%. Men solved the test by about 8% better than women, and the youngest students, those under 25 years of age, solved the test better than the other two groups by about 4%. Undergraduate and graduate nursing students were more successful than their part-time counterparts. A statistically significant difference was found between students who graduated from secondary health school compared to their colleagues who graduated from high school at the level of p=0.031, where students from health school were less successful in solving the test. Furthermore, a statistically significant difference was found between students who are licensed and those who are not licensed health workers, at a significance level of p=0.044. Students in the group with the least work experience solved the test better than their colleagues with more work experience by about 3%. Conclusion: Nursing students of the University of Split Department of Health Studies demonstrated a good ability to critically assess health claims. There was no statistically significant difference in the ability to critically assess health claims by gender and age of students. Likewise, no statistically significant difference was found according to length of service. There is a significant difference between licensed and non-licensed nursing students in the ability to critically assess health claims. Likewise, students who have completed a high school program have a better ability to critically assess health claims than students who have completed secondary health school

Inflammatory markers in patients with inflammatory bowel disease treated at University Hospital of Split in the period from January 2022 to February 2023

Cilj istraživanja: Glavni cilj ovog istraživanja bio je analizirati i usporediti vrijednosti upalnih biljega (broj leukocita, visoko osjetljivi C-reaktivni protein, brzina sedimentacije eritrocita, feritin te fekalni kalprotektin) kod oboljelih od upalne bolesti crijeva (IBD). Ispitanici i metode: U istraživanje je uključeno 40 pacijenata kojima je dijagnosticiran IBD, kao i 40 kontrolnih sudionika. Pacijenti s IBD-om raspoređeni su u podgrupe obzirom na podtip bolesti i vrstu terapije koju primaju. Svi podatci ispitanika preuzeti su iz bolničko informacijskog sustava i statistički obrađeni koristeći računalni program MedCalc. Napravljena je statistička obrada laboratorijskih parametara te osnovnih antropometrijskih i kliničkih značajki ispitanika. Rezultati: Rezultati ovog istraživanja pokazali su kako nije bilo statistički značajne razlike u antropometrijskim obilježjima oboljelih od IBD-a i kontrolne skupine, osim u tjelesnoj visini (175.0 (171.0-183.0) vs. 181.5 (173.0-190.5); p=0.024). Uočena je povećana konzumacija alkohola (p=0.002) i kave (p=0.004) kod kontrolnih sudionika. Za mjerene upalne biljege uočena je statistički značajna razlika u razini feritina (39.5 (18.0-72.5) vs. 86.5 (32.5-132.0); p=0.019), dok za druge mjerene upalne biljege nije bilo statistički značajne razlike između oboljelih od IBD-a i kontrolne skupine. Analiza podataka nije pokazala statistički značajnu razliku u antropometrijskim karakteristikama obzirom na podtip bolesti. Kod ispitanika oboljelih od Crohnove bolesti (CD) znatno češće su se javljale ekstraintestinalne manifestacije (4 (20.0%) vs. 12 (60.0%); p=0.011), a također je kod oboljelih od CD-a uočena povećana konzumacija duhana (p=0.018) za razliku od oboljelih od ulceroznog kolitisa (UC). Nadalje, nije pronađena statistički značajna razlika u razinama ispitivanih upalnih biljega obzirom na podtip bolesti i vrstu terapije koju ovi pacijenti primaju. Zaključak: Upalnu bolest crijeva karakterizira kronični upalni proces gastrointestinalnog trakta. Iako se u organizmu odvija upalna reakcija, ovim istraživanjem nisu uočene povišene vrijednosti upalnih biljega kod oboljelih od IBD-a. Laboratorijski parametri su nespecifični pokazatelj upalne bolesti crijeva, no treba ih uzeti u obzir pri postavljanju dijagnoze i procjeni aktivnosti bolesti te ih je potrebno tumačiti zajedno s kliničkom slikom pacijenta i rezultatima drugih dijagnostičkih postupaka.Objectives: The main aim of this study was to analyze and compare the values of inflammatory markers (leukocyte count, highly sensitive C-reactive protein, erythrocyte sedimentation rate, ferritin and fecal calprotectin) in patients with inflammatory bowel disease (IBD). Subjects and methods: The study included 40 patients diagnosed with IBD, as well as 40 control participants. Patients with IBD are assigned into subgroups given the subtype of the disease and the type of therapy they receive. All data of the respondents were downloaded from the hospital information system and statistically processed using the MedCalc computer program. Statistical processing of laboratory parameters and basic anthropometric and clinical characteristics of the subjects was made. Results: The results of this study showed that there was no statistically significant difference in anthropometric characteristics of patients with IBD and control group, except in body height (175.0 (171.0-183.0) vs. 181.5 (173.0-190.5); p=0.024). Increased consumption of alcohol (p=0.002) and coffee (p=0.004) was observed in the control participants. For measured inflammatory markers, a statistically significant difference in ferritin levels was observed (39.5 (18.0-72.5) vs. 86.5 (32.5-132.0); p=0.019), while for other measured inflammatory markers there was no statistically significant difference between IBD patients and the control group. The analysis of the data showed no statistically significant difference in anthropometric characteristics with respect to the subtype of the disease. In subjects suffering from Crohn's disease (CD), extraintestinal manifestations (4 (20.0%) vs. 12 (60.0%); p=0.011) were significantly more common, and also in CD patients, increased tobacco consumption (p=0.018) was observed, as opposed to patients with ulcerative colitis (UC). Furthermore, there was no statistically significant difference in the levels of inflammatory markers studied with regard to the subtype of the disease and the type of therapy these patients receive. Conclusion: Inflammatory bowel disease is characterized by a chronic inflammatory process of the gastrointestinal tract. Although there is an inflammatory reaction in the body, this study did not show elevated values of inflammatory markers in patients with IBD. Laboratory parameters are a non-specific indicator of inflammatory bowel disease, but they should be taken into account when diagnosing and assessing the activity of the disease and should be interpreted together with the clinical picture of the patient and the results of other diagnostic procedures

The effect of short.term physical therapy on hand function and pain after the bone fracture of the distal radius

Tema ovog diplomskog rada je fizioterapeutska procjena statusa šake i ručnog zgloba nakon prijeloma distalnog dijela radiusa: prije i nakon dvotjedne rehabilitacije. U svrhu istraživanja, prikupljeni su klinički i terapijski podaci ispitanika iz medicinske dokumentacije. Ključni ulazni podaci uključivali su: godina rođenja, spol, vrsta prijeloma, metoda liječenja (konzervativno ili operativno) te prisutnost komplikacija. Mjerenja su obavljena prije i nakon dvotjedne fizikalne terapije koristeći goniometar za mjerenje opsega pokreta, dinamometar za mjerenje stiska šake te upitnik QUICKDASH za procjenu funkcionalnosti šake. U istraživanju sudjelovalo je 30 ispitanika, od čega je 67% žena (N=20) i 33% muškaraca (N=10). Svi ispitanici, njih 30, pripadali su dobnoj skupini između 60 i 78 godina, s prosječnom dobi od 71,75 godina, minimalnom dobnom vrijednošću od 60 godina i maksimalnom od 78 godina. Od 30 ispitanika, njih 17 je imalo prijelome s pomakom koji su zahtijevali operativno liječenje, dok je 13 ispitanika prošlo kroz konzervativnu terapiju bez pomaka u prijelomima. Snaga šake povećala se s 20,7±4,5 prije terapije na 28,8±3,59 nakon terapije. Funkcionalnost ručnog zgloba i šake mjerena QUICKDASH upitnikom povećana je s 39.8±10.74 na 19.9±6.51 (niži postotak označava bolju funkcionalnost). Razina boli mjerena VAS skalom smanjena je s 5.6±1.38 prije terpaije na 3±1 nakon dvotjedne terapije. Opseg pokreta fleksije u ručnom zglobu povećan je s 40.9±7.93 na 50.4±8.87 nakon dvotjedne terapije. Opseg pokreta ekstenzije u ručnom zglobu povećan je s 35.6±10.69 na 45.13±9.46 nakon dvotjedne terapije. Zaključak je da dvotjedna fizikalna terapija poboljšava kretnje u ručnom zglobu nakon prijeloma distalnog dijela radiusa , smanjuje bolnost te povećava funkcionalnost osobe. Poboljšanje nakon terapije ima iznimnu važnost jer ukazuje na uspješnost tretmana i rehabilitacije te poboljšava kvalitetu života pacijenata.The topic of this master's thesis is the physiotherapeutic assessment of hand and wrist status after a distal radius fracture: before and after a two-week rehabilitation period. For the purpose of the research, clinical and therapeutic data of the participants were collected from medical records. Key input data included: date of birth, gender, type of fracture, treatment method (conservative or surgical), and the presence of complications. Measurements were taken before and after a two-week physiotherapy session using a goniometer for measuring range of motion, a dynamometer for measuring grip strength, and the QUICKDASH questionnaire to assess hand functionality. The study included 30 participants, of which 67% were women (N=20) and 33% were men (N=10). All participants, 30 in total, belonged to the age group between 60 and 78 years, with an average age of 71.75 years, a minimum age of 60 years, and a maximum age of 78 years. Out of the 30 participants, 17 had fractures with displacement requiring surgical treatment, while 13 participants underwent conservative therapy without fracture displacement. Hand grip strength increased from 20.7±4.5 before therapy to 28.8±3.59 after therapy. Hand and wrist functionality measured by the QUICKDASH questionnaire improved from 39.8±10.74 to 19.9±6.51 (a lower percentage indicates better functionality). Pain level measured using the VAS scale decreased from 5.6±1.38 before therapy to 3±1 after the two-week therapy. The range of motion for wrist flexion increased from 40.9±7.93 to 50.4±8.87 after the two-week therapy. The range of motion for wrist extension increased from 35.6±10.69 to 45.13±9.46 after the two-week therapy. In conclusion, a two-week physiotherapy session improves hand and wrist mobility after a distal radius fracture, reduces pain, and enhances the individual's functionality. Improvement after therapy is of utmost importance as it indicates the success of treatment and rehabilitation, ultimately improving the quality of life for patients

Knowledge and attitudes of the nurses of KBC Split about the Hospital Information System

Uvod: Informatizacija sustava je donijela velike i nužne promjene u cijelom zdravstvenom sustavu. Važno je omogućiti implementaciju što boljeg sustava te prilagodit radu medicinskim sestra na svakom odjelu obzirom na dinamiku i mogućnost rada. Cilj: Utvrditi stavove i znanja medicinskih sestara u KBC-u Split o bolničkom informacijskom sustavu. Metode: Istraživanje se provodilo pri KBC-u Split (klinika, zavod, odjel), a obuhvatilo je 76 ispitanika. Upitnik se ispunjavao anonimno, online putem koristeći Google Forms u trajanju od 1. prosinca 2021. do 20.prosinca 2021. godine. Rezultati: Rezultati istraživanja upućuju na različite stavove i znanja medicinskih sestara prema bolničkom informacijskom sustavu. Ispitivanjem su utvrđene i statistički obrađeni rezultati sociodemografskog dijela s obzirom na spol (χ2=64,47; P<0,001), na dob (IQR=29,50-48,50). na stupanj obrazovanja (χ2=32,63; P<0,001), radni staž (χ2=57,32; p<0,001), informatičku pismenost (χ2=33,90; P<0,001). Istraživanjem je utvrđena prosječna razina znanja iznosi koja iznosi (43,74%) sa prosječnim odstupanjem od aritmetičke sredine (12,35%). Znanje medicinskih sestara o BIS-u mjereno je temeljem tvrdnji na koje su medicinske sestre iskazivale slaganje. Najveći broj medicinskih sestara i postotak koji se potpuno složio s nekom tvrdnjom je n= 38; 50%, dok je najveći broj i postotak koji je dobiven ne slaganjem s određenom tvrdnjom n=14; (18,42). Stav medicinski sestara o sustavu mjeren je temeljem tvrdnji, gdje je utvrđeno da veliki broj medicinskih sestara ne istražuje dodatno i osobno literature vezanu za BIS (n=39; 51,32%), ali imaju potrebu za dodatnom edukacijom (n=39; 51,32%). Prosječna razina stava iznosi (28,75%) sa prosječnim odstupanjem od aritmetičke sredine (15,77%). Zaključci: Medicinske sestre KBC-a Split, istraživanjem su utvrđene pretpostavke da manji udio medicinskih sestara ima dovoljno znanja o BIS-u, te je sustav nedovoljno prilagođen različitim uvjetima rada medicinskih sestara. Utvrđeno je da nema statistički značajne razlike među medicinskim sestrama mlađim od 40. godina koje se bolje služe BIS-om, i utvrđena je potreba za dodatnom edukacijom. Statistički su utvrđene razlike u stavovima medicinskih sestara različitog stupnja obrazovanja, no nisu utvrđene razlike u znanju medicinskih sestara različitog stupnja obrazovanja.SUMMARY Introduction The informatization of the hospital system has brought about major and necessary changes in the entire health care system. It is important to enable the implementation of the best possible system and to adapt the work of nurses in each department regarding the dynamics and possibility of work. Aim: To determine the attitudes and knowledge of nurses at the Clinical Hospital Center Split about the hospital information system. Methods The research was conducted at the Clinical Hospital Center Split (clinic, institute, department), and included seventy-six respondents. The questionnaire is completed anonymously, online using Google Forms from December 1, 2021., to December 20, 2021. Results The results of the research indicate different attitudes and knowledge of nurses towards the hospital information system. The study determined and statistically processed the results of the socio-demographic part regarding gender (χ2 = 64.47; P <0.001), age (IQR = 29.50-48.50). at the level of education (χ2 = 32.63; P <0.001), work experience (χ2 = 57.32; p <0.001), computer literacy (χ2 = 33.90; P <0.001). The research determined the average level of knowledge is (43.74%) with an average deviation from the arithmetic mean (12.35%). The nurses' knowledge of BIS was measured based on the statements that the nurses agreed with. The highest number of nurses and the percentage who completely agreed with a statement is n = 38; 50%, while the maximum number and percentage obtained by disagreeing with a particular statement is n = 14; (18.42). The attitude of nurses about the system was measured based on claims, where it was found that a large number of nurses do not research additional and personal literature related to BIS (n = 39; 51.32%) but need additional education (n = 39; 51.32%). The average attitude level is (28.75%) with an average deviation from the arithmetic mean (15.77%). Conclusions Nurses of KBC Split, the research established the assumptions that a smaller proportion of nurses have sufficient knowledge about BIS, and the system is insufficiently adapted to different working conditions of nurses. It was found that there is no statistically significant difference between nurses under the age of forty who use BIS better, just as there is need for additional education. Differences in the attitudes of nurses with various levels of education were statistically determined, but no differences were found in the knowledge of nurses with various levels of education

Bismarck's model of public health financing

Često se zdravstveni sustavi opisuju prema njihovom prevladavajućem izvoru financiranja (npr. „Bismarckovi“ sustavi socijalnog zdravstvenog osiguranja, opći sustavi „Beveridge“ koji se financiraju iz poreza). Funkcioniranje zdravstva ovisi uglavnom o razini i načinu financiranja. Zemlje biraju između različitih modela. Svrha ovog rada je prikazati različite modele financiranja zdravstvene zaštite, s posebnim osvrtom na Bismarckov, Beveridgeov i američki model, kao vodećim modelima financiranja zdravstva. Na temelju literature i vlastitih razmišljanja autora, u zaključku su dati prijedlozi kako bi se spomenuti modeli poboljšali koristeći najbolje od svakog.Often, health systems are described by their prevailing source of funding (e.g., "Bismarck" social security systems, tax-funded general "Beveridge" systems). The functioning of health care depends mainly on the level and method of funding. Countries choose from different models. The purpose of this paper is to present different models of health care financing, with special reference to Bismarck', Beveridge's and American models, as leading models of health care financing. Based on the literature and the author's own reflections, suggestions were made in conclusion to improve the models using the best of each

COMPARISON OF INTERVENTIONS IN PRE-COVID AND COVID PERIOD IN THE DEPARTMENT OF EMERGENCY MEDICINE OF SPLIT-DALMATIA COUNTY

Cilj: Cilj ovog rada je usporediti učestalost intervencija (pregleda) pacijenata koji su pod određenom prijemnom dijagnozom liječeni u Zavodu za hitnu medicinu Splitsko-dalmatinske županije (ZHM SDŽ) u godini prije (2019./2020.) i u godini za vrijeme (2020./2021.) pandemije COVID-19. Materijali i metode: U ovo retrospektivno istraživanje uključeni su svi pacijenti liječeni u Zavodu za hitnu medicinu Splitsko-dalmatinske županije (ZHM SDŽ) od veljače 2019. do veljače 2021. godine. Podaci o dobi, spolu te prijemnoj dijagnozi pacijenata po MKB-10 klasifikaciji prikupljeni su iz informacijskog sustava e-Hitna. Rezultati: Značajna razlika u učestalosti prijemnih dijagnoza u pre-COVID razdoblju u odnosu na COVID razdoblje na ukupnom uzorku od 214 862 ispitanika utvrđena je u razredima R00-R99 (Simptomi, znakovi i abnormalni klinički i laboratorijski nalazi, neklasificirani drugdje), S00-T98 (Ozljede, trovanja i određene druge posljedice s vanjskim uzrokom) te J00-J99 (Bolesti dišnog sustava) na razini značajnosti p<0,001. Nadalje značajna razlika utvrđena je u razredu I00-I99 (Bolesti cirkulacijskog sustava) na razini p=0,001 dok je razred H60-H95 (Bolesti uha i mastoidnih procesa) pokazao značajnost p=0,002. U pre-COVID razdoblju utvrđena je značajna razlika prema spolu, gdje su žene imale veći broj prijemnih dijagnoza u odnosu na muškarce, u razredima N00-N99 (Bolesti genitalno-urinarnog sustava) (p=0,001) te u razredu R00-R99 (p<0,001). U istom razdoblju muškarci su se značajno razlikovali od žena u razredu S00-T98 na razini p<0,001. U COVID razdoblju utvrđena je značajna razlika prema spolu, gdje su muškarci imali veći broj prijemnih dijagnoza u odnosu na žene, u razredu S00-T98 na razini p<0,001, dok su žene imale više prijemnih dijagnoza u razredima R00-R99 na razini p<0,001, I00-I99 na razini p=0,001 te N00-N99 (p=0,005). Zaključci: Veći broj pacijenata zaprimljen je u ZHM SDŽ u godini koja je prethodila pandemiji nego u godini s pandemijom COVID-19. Iako je COVID-19 primarno bolest dišnog puta, više je pacijenata zaprimljeno pod tom prijemnom dijagnozom u godini prije pandemije COVID-19, što je vjerojatno razlog organizacije zdravstvenog sustava (direktan odlazak na COVID-19 prijeme) te sam učinak izolacije i samoizolacije (smanjen kontakt među ljudima). Pridržavanje načela zatvaranja također je vjerojatni čimbenik koji je doprinio značajnom smanjenju broja ozljeda i trovanja (prometne nesreće, traume, radne ozljede...).Summary: Objective: The aim of this paper is to compare the frequency of interventions (examination) of patients who were treated at a certain admission diagnosis at the Department of Emergency Medicine of Split-Dalmatia County (ZHM SDŽ) in the year before (2019/2020) and in the year during (2020/2021) COVID-19 pandemic. Materials and methods: This retrospective study included all patients treated at the Department of Emergency Medicine from February 2019 to February 2021. Data on age, sex and diagnosis of patients by ICD-10 classification were collected from medical program e-Hitna. Results: A significant difference in the frequency of admission diagnoses in the pre-COVID period compared to the COVID period on a total sample of 214 862 subjects were found in classes R00-R99 (Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified) , S00-T98 (Injuries, poisonings and certain other consequences with external cause) and J00-J99 (Respiratory diseases) at the level of significance p <0.001. Furthermore, a significant difference was found in class I00-I99 (Diseases of the circulatory system) at the level of p = 0.001 while class H60-H95 (Diseases of the ear and mastoid processes) showed a significance of p = 0.002. In the pre-COVID period, a significant gender difference was found, where women had a higher number of admission diagnoses than men in classes N00-N99 (Diseases of the genitourinary system) (p = 0.001) and in class R00-R99 (p <0.001). In the same period, men differed significantly from women in the S00-T98 class at the p <0.001 level. In the COVID period, a significant gender difference was found, where men had a higher number of admission diagnoses than women in class S00-T98 at the level of p <0.001, while women had more admission diagnoses in classes R00-R99 at the level of p <0.001, I00-I99 at p = 0.001 and N00-N99 (p = 0.005). Conclusions: A larger number of patients were admitted to ZHM SDŽ in the year preceding the pandemic than in the year with the COVID-19 pandemic. Although COVID-19 is primarily a respiratory disease, more patients were admitted under this admission diagnosis in the year before the COVID-19 pandemic, which is probably due to organization of the health system (direct access to COVID-19 admissions) and the effect of isolation and self-isolation (less contact between people). Adherence to the principle of lockdown is also a likely factor that has contributed to a significant reduction in the number of injuries and poisonings (traffic accidents, trauma, work injuries...)