Percepcije hrvatskih kirurga o mogućnosti primjene marketinga usluga u zdravstvenim organizacijama

This paper deals with the reflections on the problems involved in the marketing of health care services. There are a number of particularities and limitations requiring a creative approach to the application of marketing to health care organizations. The first part of the paper summarizes theoretical contributions on specific characteristics of services marketing in health care. Exploratory research of the perceptions among surgeons of health services marketing, which is described in the second part, provides a useful insight into the possibility of applying marketing to specialist surgical services. Research was conducted among general surgeons employed at Croatian public health care organizations. Results show a discrepancy between the awareness of services marketing and its application to surgical practice. Continuous education is necessary to better acquaint surgeons with services marketing as a business philosophy, which may improve performance in the provision of health services.Ovaj rad razmatra problematiku marketinga zdravstvenih usluga. Puno je posebnosti i ograničenja koja zahtijevaju kreativan pristup primjeni marketinga u zdravstvenim organizacijama. U prvom su dijelu sažeto prikazani teorijski doprinosi specifičnostima marketinga usluga u zdravstvu. Izviđajno istraživanje percepcija kirurga o marketingu usluga, opisano u drugom dijelu rada, pruža koristan uvid u moguću primjenu marketinga pri pružanju specijalističkih kirurških usluga. Istraživanje je provedeno na ukupnoj populaciji općih kirurga koji su zaposleni u javnozdravstvenim ustanovama u Republici Hrvatskoj. Rezultati pokazuju nesklad između upoznatosti s marketingom usluga i njegovom primjenom u kirurškoj praksi. Potrebno je provoditi kontinuiranu edukaciju kako bi se kirurge bolje upoznalo s marketingom usluga kao poslovnom filozofijom koja može poboljšati način pružanja specijalističkih zdravstvenih usluga

Perceptions among Croatian surgeons of services marketing application to health care organizations

This paper deals with the reflections on the problems involved in the marketing of health care services. There are a number of particularities and limitations requiring a creative approach to the application of marketing to health care organizations. The first part of the paper summarizes theoretical contributions on specific characteristics of services marketing in health care. Exploratory research of the perceptions among surgeons of health services marketing, which is described in the second part, provides a useful insight into the possibility of applying marketing to specialist surgical services. Research was conducted among general surgeons employed at Croatian public health care organizations. Results show a discrepancy between the awareness of services marketing and its application to surgical practice. Continuous education is necessary to better acquaint surgeons with services marketing as a business philosophy, which may improve performance in the provision of health services

Kirurško liječenje metastaza kralježnice

Spinal metastatic disease is a rather common occurrence and definitely warrants attention and treatment due to the high likelihood of leaving cancer patients severely disabled in their final months of life. Recent developments in the understanding of the behavior of different tumor types, as well as advances in surgical treatment, are allowing for the evolution of treatment algorithms, especially when surgical treatment is to be considered. Th is paper gives an overview of the decisionmaking process and the array of surgical options currently available.Metastatska bolest kralježnice je dosta učestala i zasigurno zaslužuje pozornost i liječenje zbog visoke vjerojatnosti da bi inače bolesnici s karcinomom ostali oduzeti u svojim posljednjim mjesecima života. Novija postignuća i shvaćanja ponašanja raznih tipova tumora te unaprjeđenja u kirurškim tehnikama omogućuju evoluciju algoritama, pogotovo kada se kirurško liječenje razmatra. Ovaj rad daje pregled postupka donošenja odluka i ističe razne kirurške mogućnosti koje su trenutno dostupne

Artroskopska tehnika “sve unutar zgloba” za rekonstrukciju rupturiranog meniska

The most frequent indication for surgical treatment of the knee is lesion of the meniscus. The “all inside” arthroscopic technique with bioresorptive material for meniscus lesion is becoming the most popular treatment. This prospective study included 10 patients with posterior meniscal horn lesion operatively treated at Sports Traumatology Department. The “all inside” technique was performed by intra-articular application of bioresorptive pins-Darts sticks or Meniscus Viper and bioresorptive string. Patients were followed up for 2-6 months postoperatively and graded according to the IKDC 2000 scale. All surgical treatments showed satisfactory results. Young patients with acute longitudinal peripheral lesion-posterior horn lesions, in the red-red or red-white meniscal zone, 1-2 centimeters long are most appropriate for this type of treatment. In these patients, this technique proved to be superior and free from the risk of neurovascular damage. For better authentication of this conclusion, additional prospective randomized studies should be performed.Ozljeda meniska je najčešća indikacija za kirurško liječenje koljena. Artroskopska tehnika “sve unutar zgloba” (“all inside”) za rekonstrukciju lezije meniska upotrebom bioresorpcijskih materijala sve je popularniji način liječenja ozljeda meniska. Prospektivno je analizirano iskustvo u operacijskom liječenju 10 bolesnika zbog ozljede stražnjeg roga meniska na Traumatološkom odjelu. Tehniku “sve unutar zgloba” proveli smo intraartikularnom aplikacijom bioresorpcijskih pinova Darts sticks i/ili upotrebom Vipera meniska i bioresorpcijskog konca. Bolesnici su praćeni tijekom poslijeoperacijskog razdoblja od 2 do 6 mjeseci, a rezultati svih postupaka ocjenjivani prema ocjenskoj ljestvici IKDC 2000 za koljenski zglob su bili zadovoljavajući. Idealni kandidati za takav zahvat su mlađe osobe s akutnom, longitudinalnom, perifernom lezijom, tj. stražnji rog, u crveno-crvenoj ili crveno-bijeloj zoni meniska, dužine 1-2 cm. U takvih bolesnika, tehnika “sve unutar zgloba” u liječenju ozljede meniska pokazala se vrlo dobrom, jer omogućuje cjelokupan intraartikularni tretman bez rizika od neurovaskularnih ozljeda. Za procjenu vjerodostojnosti takvih zaključaka potrebne su veće prospektivne randomizirane studije

Surgical treatment of spondylodiscitis

Spondilodiscitis se u većini slučajeva može liječiti konzervativno, ali kompliciraniji slučajevi koji uključuju prijeteći ili postojeći neurološki ispad, nestabilnost i deformitet kralježnice, jake bolove, epiduralni apsces i neuspjeh konzervativnog liječenja zahtijevaju kirurško liječenje. Ciljevi operativnog liječenja spondilodiscitisa su odstranjenje nekrotičnog tkiva i dekompresija neuralnih struktura, uzimanje tkiva za patohistološku dijagnozu i mikrobiološku potvrdu uzročnika, stabilizacija kralježnice, te rana mobilizacija pacijenta. Moderna kirurška tehnika koristi stražnji pristup, prednji pristup i kombinirani pristup u jednom ili dva stupnja, a kirurg je vođen lokalizacijom spondilodiscitisa i individualnim pristupom pacijentu. Stabilnost kralježnice se postiže transpedikularnom fiksacijom titanskim vijcima i stupićima, a prednja kolumna torakolumbalne kralježnice se nakon odstranjenja nekrotičnog tkiva rekonstruira trikortikalnim koštanim presatkom iz zdjelice ili titanskim kavezima ispunjenim spongioznom kosti. U kirurškom liječenju spondilodiscitisa vratne kralježnice stabilnost se postiže prednjim pločama sa zaključanim vijcima i/ili stražnjom stabilizacijom vratne kralježnice. Korist stabilizacije kralježnice titanskim implantatima nadilazi manjkavost implantacije stranog materijala na mjestu upale.In most cases spondylodiscitis can be treated conservatively, though complicated cases with pending or already existent neurological deficit, focal instability or deformity of the spine with acute pain have to be treated by surgical correction and instrumentation. Surgery is absolutely indicated in cases with epidural abscess formation and in cases in which conservative treatment have given no success. Goals of surgical treatment of spondylodiscitis are debridement of necrotic and infected tissues, decompression of neural structures, obtaining specimens for bacteriological and pathohystological diagnostics, and obtainment of spine stability, making possible early mobilization of the patient. Anterior, posterior or combined approaches can be utilized, being performed in single stage of staged procedure. Leading facts determining surgeon\u27s tactics being localisation of inflammatory process and individual approach to the patient. Stability of the spine is achived by transpedicular fixation by screws and longitudinal rods, and by reconstruction of anterior column by means of cancellous bone filled titanium cages or by autologous structural bone grafting. In cervical spine surgical stability is achieved by anterior locking plates, and/or by posterior screw and rod system instrumentation. Benefit given by stabilized spine outpaces the risk of implanting metal implants in potentially contaminated area

Surgical treatment of spondylodiscitis

Spondilodiscitis se u većini slučajeva može liječiti konzervativno, ali kompliciraniji slučajevi koji uključuju prijeteći ili postojeći neurološki ispad, nestabilnost i deformitet kralježnice, jake bolove, epiduralni apsces i neuspjeh konzervativnog liječenja zahtijevaju kirurško liječenje. Ciljevi operativnog liječenja spondilodiscitisa su odstranjenje nekrotičnog tkiva i dekompresija neuralnih struktura, uzimanje tkiva za patohistološku dijagnozu i mikrobiološku potvrdu uzročnika, stabilizacija kralježnice, te rana mobilizacija pacijenta. Moderna kirurška tehnika koristi stražnji pristup, prednji pristup i kombinirani pristup u jednom ili dva stupnja, a kirurg je vođen lokalizacijom spondilodiscitisa i individualnim pristupom pacijentu. Stabilnost kralježnice se postiže transpedikularnom fiksacijom titanskim vijcima i stupićima, a prednja kolumna torakolumbalne kralježnice se nakon odstranjenja nekrotičnog tkiva rekonstruira trikortikalnim koštanim presatkom iz zdjelice ili titanskim kavezima ispunjenim spongioznom kosti. U kirurškom liječenju spondilodiscitisa vratne kralježnice stabilnost se postiže prednjim pločama sa zaključanim vijcima i/ili stražnjom stabilizacijom vratne kralježnice. Korist stabilizacije kralježnice titanskim implantatima nadilazi manjkavost implantacije stranog materijala na mjestu upale.In most cases spondylodiscitis can be treated conservatively, though complicated cases with pending or already existent neurological deficit, focal instability or deformity of the spine with acute pain have to be treated by surgical correction and instrumentation. Surgery is absolutely indicated in cases with epidural abscess formation and in cases in which conservative treatment have given no success. Goals of surgical treatment of spondylodiscitis are debridement of necrotic and infected tissues, decompression of neural structures, obtaining specimens for bacteriological and pathohystological diagnostics, and obtainment of spine stability, making possible early mobilization of the patient. Anterior, posterior or combined approaches can be utilized, being performed in single stage of staged procedure. Leading facts determining surgeon\u27s tactics being localisation of inflammatory process and individual approach to the patient. Stability of the spine is achived by transpedicular fixation by screws and longitudinal rods, and by reconstruction of anterior column by means of cancellous bone filled titanium cages or by autologous structural bone grafting. In cervical spine surgical stability is achieved by anterior locking plates, and/or by posterior screw and rod system instrumentation. Benefit given by stabilized spine outpaces the risk of implanting metal implants in potentially contaminated area