Utjecaj duboke mozgovne stimulacije na kvalitetu života bolesnika s Parkinsonovom bolešću

Introduction. Deep Brain Stimulation (DBS) is an electrical stimulation of the individual cells of the central nervous system. DBS is today most often used to treat movement disorders such as Parkinson\u27s disease, dystonia, Tourette syndrome etc. The goal of DBS is improving the quality of life of patients, specifically by improving their motor function, reduction in drug therapy they use as well as reducing pain and neurological deficits. Methods. We analyzed the quality of life pre- and post-operatively in 95 patients with DBS implantations. The patients were operated on at the Department of Neurosurgery of the University Hospital Dubrava in Zagreb for treating Parkinson’s disease. The patients which were included were operated on from 2007-2015. All patients underwent this highly specialized procedure that consists of implanting electrodes in the subthalamic nuclei (STN) as well as extension and battery implantation. Results. Four characteristics were analyzed: the patient’s ability to clothe, eat and walk independently without assistance as well as their overall satisfaction with the quality of life after the procedure. After the onset of the stimulation, improvement wwas seen in all of the observed parameters. Conclusion. This kind of procedure has been shown to be justified in treating Parkinson’s disease symptoms and improving the quality of life and independence in these patients.Uvod. Duboka mozgovna stimulacija jest ciljana primjena električnih stimulacija na pojedine stanice središnjega živčanog sustava. Najčešća je primjena duboke mozgovne stimulacije kod neuroloških oboljenja kao što su Parkinsonova bolest, distonija, Touretteov sindrom i sl. Cilj je primjene duboke mozgovne stimulacije smanjenje medikamentozne terapije, poboljšanje motoričke funkcije, smanjenje boli i neurološkog deficita te poboljšanje kvalitete života. Metode. Analizirali smo devedeset i pet dubokih mozgovnih implantacija učinjenih na Zavodu za neurokirurgiju Kliničke bolnice Dubrava u svrhu liječenja Parkinsonove bolesti u razdoblju od 2007. do 2015. godine. Svim je bolesnicima učinjena visokospecijalizirana operacija kojom se implantiraju elektrode u suptalamičku jezgru (STN) te se provedu ekstenzije i implantira baterija. Rezultati. Četiri su parametra ispitana prije i poslije operacije: bolesnikova mogućnost samostalnog oblačenja, jedenja i hodanja te njihov osobni dojam kvalitete života i mogućnosti samostalnog života. Nakon stimulacije, ukupno gledajući, došlo je do poboljšanja u sve četiri navedene kategorije. Zaključak. Duboka mozgovna stimulacija pokazala se posve opravdanom kod bolesnika s Parkinsonovom bolešću, pomažući u poboljšanju kvalitete života bolesnika

Povijest i evolucija sestrinstva u operacijskoj dvorani The history and evolution of nursing in the operating room

Pojava sestrinstva u operacijskoj dvorani povezana je s uvođenjem aseptičkih tehnika, što je omogućilo obavljanje operacija visoke složenosti, a medicinske sestre su su odgovorne za brigu o kirurškim instrumenima. Razvoj je bio izražen posebno tijekom Drugog svjetskog rata zbog potražnje za sestrama koje su imale znanja vezana uz operacije, uključujući anesteziju, da rade kao supervizori pomoćnom osoblju te da se brinu za operirane pacijente. Danas je perioperativna zdravstvena njega visoko specijalizirano područje zdravstvene njege. Gotovo sve zemlje EU imaju posebnu edukaciju za buduće operacijske sestre. U Hrvatskoj se operacijske sestre/tehničari educiraju u operacijskoj dvorani, prijenosom znanja sa starijih na mlađe kolege, što nije u skladu s europskim smjernicama i preporukama

Povijest i evolucija sestrinstva u operacijskoj dvorani The history and evolution of nursing in the operating room

Pojava sestrinstva u operacijskoj dvorani povezana je s uvođenjem aseptičkih tehnika, što je omogućilo obavljanje operacija visoke složenosti, a medicinske sestre  odgovorne su za brigu o kirurškim instrumenima. Razvoj je bio intenzivan, osobito tijekom Drugog svjetskog rata, zbog potražnje za sestrama koje su imale znanja vezana uz operacije, uključujući anesteziju, da rade kao supervizori pomoćnom osoblju te da se brinu za operirane pacijente. Danas je perioperativna zdravstvena njega visoko specijalizirano područje zdravstvene njege. Gotovo sve zemlje Europske unije imaju posebnu edukaciju za buduće operacijske sestre. U Hrvatskoj se operacijske sestre/tehničari educiraju u operacijskoj dvorani, prijenosom znanja sa starijih na mlađe kolege, što nije u skladu s europskim smjernicama i preporukama

Brain tumor biopsy using robot "Ronna"

Stereotaksijska neurokirurgija ima bogatu povijest. S ciljem povećanja točnosti stereotaksijske biopsije osmišljeno je nekoliko stereotaksijskih okvira. Trenutno je najčešće korišteni Leksellov okvir. Svrha je okvira točno pozicioniranje glave unutar koordinatnog sustava te određivanje koordinata ciljne točke predviđene za biopsiju. Stereotaksija se osim za biopsiju tumora na mozgu koristi i za duboku mozgovnu stimulaciju kod bolesnika koji boluju od Parkinsonove bolesti te distonije. Najnoviji stereotaksijski sustav je robotski sustav stereotaksije i navigacije koji se koristi za biopsiju tumora i duboke mozgovne stimulacije. Za uspješnost operacije nužna je visoka točnost, s pogreškom manjom od 2 mm. U okviru diplomskog rada prikazani su rezultati presječne studije točnosti i učinkovitosti biopsije izvedene uz pomoću robota RONNA kod 30 pacijenata. U nastavku studije rezultati će biti uspoređeni s rezultatima klasične biopsije izvedene pomoću Leksellovog okvira. Kod stereotaksijske biopsije robotskim sustavom RONNA pogreška je iznosila 1,4 mm. Nadalje, navedeni operativni zahvat traje kraće od klasične biopsije te omogućuje bržu i jednostavniju promjenu plana biopsije.Stereotactic neurosurgery has a rich history. Several stereotaxic frameworks have been designed in order to increase the accuracy of stereotactic biopsy. Currently, the most commonly used frame is Leksell frame. The purpose of the frame is to accurately position the head within the coordinate system and to determine the coordinates of the target point intended for biopsy. In addition to biopsy of brain tumors, stereotaxy is also used for deep brain stimulation in patients with Parkinson's disease and dystonia. The latest stereotactic system is a robotic stereotactic and navigation system used for tumor biopsy and deep brain stimulation. High accuracy, with an error of less than 2 mm, is necessary for the success of the operation. Within thos master thesis the results of a cross-sectional study of the accuracy and effectiveness of biopsies performed using the robot "Ronna" in 30 patients are presented. In the continuation of the study, obtained results will be compared with the results of a classical biopsy performed using the Leksell framework. In the stereotactic biopsy with the Ronna robotic system, the error was 1.4 mm. Furthermore, the mentioned surgical procedure is shorter than the classic biopsy and enables a faster and easier change of the biopsy plan

PUBLIC ADMINISTRATION IN THE BALKANS from Weberian Bureaucracy to New Public Management

The current volume reproduces papers presented in the Workshop which was organized in Athens, in February 2010 by the European Public Law Organization (EPLO) and the Faculty of Public Administration – National School of Political Studies and Public Administration (NSPSPA), Bucharest. The workshop entitled “Public Administration in the Balkans – from Weberian bureaucracy to New Public Management” has aimed to reveal relevant aspects on the developments of national public administrations in some Balkan states related to the traditional or actual models of the administrative organization. The organizers have proposed to approach theoretical and practical aspects focusing on Weberian bureaucracy and New Public Management (NPM). In this context, the general framework of debates was based both on specificity of public administration in the Balkan states and the European integration process, particularly the enlargement of the European Administrative Space to the Balkan area. As shown by a profound analysis in the papers, the characteristics of the public administrations are moreover diverse and get closer to the developments of the public administrations in Europe, such as the Mediterranean ones (Greece, Cyprus etc.) or those of the states in transition (Bulgaria, Romania, Croatia, Serbia etc.). The interactions with different intensities between Weberianism and New Public Management emphasise, generally, the characteristics of “a new Weberian state” (NWS) for the Balkan states (Pollitt and Bouckaert, 2004, Meneguzzo et al, 2010), revealing a higher NPM impact (Cyprus, Greece, Croatia etc.) or a lower one (Bulgaria, Romania, Serbia, Slovenia etc.). NWS represents a metaphor describing a model that co-opts the passive elements of NPM, but on a Weberian foundation (Pollitt and Bouckaert, 2004, Brown, 1978). The fact that the Balkan states belong more or less explicit to NWS triggers their position in post-NPM era, thus the state remaining an important actor, able to facilitate the public-private dialogue and to sustain the processes for enhancing the effectiveness of public services and administration. The public administration reforms in the Balkan states have targeted one or several European models of national administrations. Even if the concepts on reform comprise visible differences, the tradition, geo-political specificity, human and material resources have determined similarities and common characteristics, which could be emphasized in the development and actual status of administration in the Balkan states. At the same time, the administrative reforms have already introduced elements that enable the administrations in the Balkan states to get closer to the features of “public governance”. Herewith we refer mainly to participating in decision-making, introducing the elements of “neo-corporatism” governance etc. The capacity of adaptation and openness represent a valuable feature of the Balkan administrations, most of them holding systemic connections of low intensity, thus being far away from what we call “strong administration”, found especially in the European developed states. Recent studies support the above ideas, referring to “main drivers of public administration modernization”, placing most Balkan states in the “very low” or “medium” area (Demmke et al., 2006). When referring to open government or ethics, the same studies place the Balkan states under the heading “very high influence”. Based on the above assertions, the papers emphasize concrete issues that could be synthesized in some large categories: - Balkan public administrations between tradition and modernity; - National experiences on the impact of the administrative reforms in Balkan states; - Myth or reality in considering “a Balkan model of public administration”; - Administrative convergence and dynamics as support of the evolution towards a certain model; - Assessing relevant case studies on enforcing NPM in local governance. It is also worth to mention that the approach of the participants in the workshop has been marked by the institutional innovations and trends in European governance, the debates concerning the model and characteristics of the European administration etc. The workshop was organized within the framework of Jean Monnet project “South-Eastern European developments on the administrative convergence and enlargement of the European Administrative Space in Balkan states” with the financial support of the European Community