13 research outputs found
Sindrom izgaranja kod anesteziologa u radu s COVID bolesnicima na mehaniÄkoj ventilaciji u KliniÄkom bolniÄkom centru Osijek
This study aimed to examine the incidence and intensity of burnout syndrome among
the anesthesiologists who worked with COVID patients in the COVID intensive care unit (Respiratory
Centre) and among anesthesiologists and clinicians who did not work in a respiratory ICU during
the pandemic in order to compare the difference in the incidence of burnout syndrome and to examine
whether there is a difference in burnout syndrome regarding gender, age and level of medical education.
Therefore, a cross-sectional study was conducted. The study included 60 participants; 30 of whom were
physicians who worked in the respiratory ICU and 30 who did not work in the respiratory ICU during
the COVID-19 pandemic. The results were obtained using a questionnaire to classify participants as being
without burnout symptoms, in the initial phase of burnout, or having a high degree of burnout. Based
on the results, we found that 53% of all physicians presented with burnout syndrome, and the majority
of them were anesthesiologists (30%). Furthermore, 37% of anesthesiologists were in the group with an
initial phase of burnout and 20% in the group with a high burnout. Among female anesthesiologists, the
syndrome was observed in 58% of all cases. In the group of anesthesiologists older than 35 years, 59% of
the cases of burnout syndrome were present, where as burnout syndrome was present in 54% of younger
anesthesiologists (younger than 35 years old). There was a higher proportion of burnout syndrome among
the participants than in previous studies. The anesthesiologists who worked with seriously ill COVID patients
during the pandemic were predominant among the physicians with a higher proportion of burnout
syndrome. Symptoms were more common among women, physicians older than 35 and specialists.Cilj ovog istraživanja bio je ispitati pojavnost i intenzitet sindroma izgaranja meÄu anesteziolozima koji su radili u covid
jedinici intenzivnog lijeÄenja (respiracijski centar), usporediti razliku pojavnosti sindroma izgaranja izmeÄu njih i lijeÄnika
koji u vrijeme pandemije nisu radili u covid jedinici intenzivnog lijeÄenja, te ispitati postoji li razlika pojavnosti sindroma
izgaranja meÄu anesteziolozima s obzirom na spol, dob i specijalistiÄko usavrÅ”avanje. U tu svrhu provedena je presjeÄna studija.
Istraživanje je provedeno na 60 lijeÄnika od kojih je 30 lijeÄnika koji su u vrijeme pandemije bolesti COVID-19 radili u
respiracijskom centru te 30 lijeÄnika koji u istom razdoblju nisu radili u respiracijskom centru. Rezultati su prezentirani uz
pomoÄ upitnika Äiji zbroj ispitanike svrstava u skupinu bez izgaranja, poÄetnog izgaranja ili visokog stupnja izgaranja. Na
temelju istraživanja utvrÄeno je da se 53% lijeÄnika prezentira sindromom izgaranja, a veÄinu meÄu njima Äine anesteziolozi.
MeÄu njima je 37% anesteziologa koji imaju poÄetno izgaranje i 20% njih koji pripadaju skupini visokog izgaranja. U žena je
sindrom prepoznat meÄu 58% ispitanica. U skupini starijih od 35 godina prisutno je 59% sluÄajeva sindroma izgaranja, dok je
ta brojka meÄu specijalistima 75%. U ukupnom uzorku utvrÄen je veÄi udio sindroma izgaranja nego Å”to su to pokazala prethodna
istraživanja. MeÄu njima prevladavaju lijeÄnici Klinike za anesteziologiju koju su u vrijeme pandemije radili s teÅ”ko
bolesnim COVID pacijentima. U skupini ispitanih anesteziologa simptomi su bili ÄeÅ”Äi meÄu ženama, meÄu lijeÄnicima
starijim od 35 godina te meÄu specijalistima
Epidemiologija prijeloma kosti u odrasloj dobi prema uzroku ozljede, lokaciji prijeloma i vrsti lijeÄenja u istoÄnoj Hrvatskoj
Th is retrospective study investigated the impact of age on fracture occurrence through the comparison of two patient groups, 17-64 and 64+ age groups. Study data covered all fractures treated at a large hospital in eastern Croatia. A total of 15,519 patients with fractures were treated at the trauma department (inpatient and outpatient), with a total of 17,257 fractures presented, 71% managed as outpatients and 29% as inpatients. A total of 11,046 outpatients were treated for 12,187 fractures and a total of 4473 inpatients were treated for 5070 fractures. Th e group of 17-64-year old males had 5787 fractures, accounting for 34% of all fractures presented. Th e group of 17-64-year old females had 4094 fractures, accounting for 24% of total fractures. Th e group of 65+ year-old males had 2659 fractures, accounting for 15% of all fractures presented and the group of 65+ year-old females presented with 4717 fractures, accounting for 27% of all fractures presented. Th e āfall in levelā was the predominant cause of injury in all patients. Th e characteristics of osteoporotic bone fractures were evident in the population of 65+ females and to a lesser degree in 65+ males. Th e 17-64 age group, both males and females, had more fractures considered as high-energy fractures.U ovoj retrospektivnoj studiji procijenjena je ovisnost prijeloma kosti o dobi ispitanika kroz usporedbu dviju skupina bolesnika u dobi od 17-64 i 65+ godina. Svi bolesnici su lijeÄeni na traumatoloÅ”kom odjelu najveÄe bolnice u istoÄnoj Hrvatskoj, stacionarno ili ambulantno. Ukupan broj bolesnika bio je 15.519 sa 17.257 prijeloma. Prema naÄinu lijeÄenja 71% bolesnika lijeÄeno je ambulantno, a 29% stacionarno; 11.046 ambulantnih bolesnika su lijeÄeni zbog 12.187 prijeloma, dok su 4473 stacionarna bolesnika lijeÄeni zbog 5070 prijeloma. Skupina bolesnika muÅ”kog spola u dobi od 17-64 godine imala je 5787 prijeloma, tj. 34% od ukupnog broja prijeloma. Skupina bolesnica u dobi od 17-64 godine imala je 4094 prijeloma, tj. 24% od ukupnih prijeloma. MuÅ”karci stariji od 65 godina su imali 9717 prijeloma ili 27% od ukupnih prijeloma. āPad u raziniā bio je najÄeÅ”Äi uzrok ozljeÄivanja. Osteoporotski prijelomi bili su ÄeÅ”Äi u skupini žena starijih od 65 godina nego kod muÅ”karaca iste dobi. Prijelomi u populaciji u dobi od 17-64 godine kod oba spola bili su obilježeni kao ozljeda visoke energije
Perkutana laserska dekompresija diska zbog lumbalne radikularne boli: sistemski pregled PubMeda zadnjih pet godina
The most common causes of lumbar radicular pain are pathological changes in the
intervertebral disc. Lumbar disc herniation (LDH) is the most common cause of lumbosacral radicular
syndrome. It affects 1-2% of the general population, burdening health services and the economy worldwide.
Excessive scar tissue after lumbar microdiscectomy can increase postoperative pain. Postoperative
fibrosis is one of the most important causes of failed back surgery syndrome after lumbar disc surgery.
Percutaneous laser disc decompression (PLDD) is a minimally invasive procedure in which thermal
energy produced by a LASER probe is used to reduce the intervertebral disc herniation located within
the annulus fibrosus. Evaporation of a small volume in a closed hydraulic space (nucleus pulposus) leads
to decreased intradiscal pressure. It causes a thermal āshrinkage effectā with the retreat of the herniated
disc and the decompression of the nerve root, which reduces lumbar radicular pain. Previous research
has shown effective reduction of pain after PLDD and only a small number of complications of the
procedure itself. PLDD is a safe and effective procedure in well-selected patients. Unfortunately, there is
still a need for extensive, randomized prospective studies on PLDD in lumbar radicular pain in order to
confirm or dispute the results obtained so far.NajÄeÅ”Äi uzrok lumbalne radikularne boli su patoloÅ”ke promjene intervertebralnog diska. Lumbalna diskus hernija
(LDH) je najÄeÅ”Äi uzrok lumbosakralnog radikularnog sindroma i pogaÄa 1-2% opÄe populacije, stavljajuÄi znaÄajan teret na
zdravstvene usluge i gospodarstvo u cijelom svijetu.
Prekomjerna koliÄina ožiljnog tkiva nakon lumbalne mikrodiscektomije može poveÄati postoperativnu bol. Postoperativna
fibroza je jedan od najvažnijih uzroka sindroma neuspjele operacije leÄa nakon operacije lumbalnog diska.
Perkutana laserska dekompresija diska (PLDD) je vrsta minimalno invazivnog zahvata u kojem se toplinska energija
proizvedena LASER sondom koristi za smanjenje hernije interverterbralnog diska koja se nalazi unutar fibroznog prstena.
Isparavanje malog volumena u zatvorenom hidrauliÄkom prostoru (nucleus pulposus) dovodi do smanjenja intradiskalnog
tlaka i implicira termiÄki āuÄinak skupljanjaā sa povlaÄenjem hernije diska i dekompresiju živÄanog korijena Å”to ima za posljedicu
smanjenja lumbalne radikularne boli.
DosadaÅ”nja istraživanja pokazala su uÄinkovito smanjenje boli poslije PLDD, te mali broj komplikacija samog zahvata.
PLDD je siguran i djelotvoran zahvat kod dobro probranih bolesnika. Nažalost, ne postoje joŔ velike, randomizirane prospektivne
studije iz PLDD kod lumbalne radikularne boli, te su navedena istraživanja potrebna u buduÄnosti kako bi potvrdila
ili osporila dosadaŔnje rezultate
Razlike u mjerenjima brzine otkucaja srca te broja uÄinjenih koraka usporedo mjerenih skupim i jeftinim pametnim satom
Cilj ovoga istraživanja bio je ispitati razliku izmeÄu mjerenja brzine otkucaja srca te broja uÄinjenih koraka, mjerenih istovremeno skupim i jeftinim pametnim satom, uz statistiÄku obradu prikupljenih podataka Passing Bablok regresijskom analizom. StatistiÄka metoda Passing Bablok regresijske analize služi za usporedbu mjerenja iste varijable s dva razliÄita mjerna instrumenta, a svrha istraživanja bila je ispitati koliko se korisnici pametnih satova mogu osloniti na rezultate mjerenja dobivene ovim ureÄajima. Mjerenja su izvrÅ”ena na jednome ispitaniku, autoru ovoga istraživanja, s po jednim satom na svakoj ruci uz povremenu izmjenu ruku. Ovim istraživanjem potvrÄeno je da postoji razlika u mjerenjima izmeÄu dva pametna sata, kako meÄusobno tako i s obzirom na samostalno mjerenje koraka i otkucaja srca. MeÄutim, potrebna su daljnja istraživanja koja bi pokazala koji je sat toÄniji te koliko odstupa od stvarnih vrijednosti uvoÄenjem drugih modela satova te referentnih mjernih ureÄaja. ZakljuÄno, pametni sat može se koristiti u privatne svrhe radi okvirnoga praÄenja fizikalnih veliÄina, no ostaje upitna njegova toÄnost kao potencijalnoga izvora za medicinsku dijagnostiku
Influence of Work Motivation, Work Environment and Job Satisfaction on Turnover Intention of Croatian Nurses: A Qualitative Study
Aim: The purpose of this study was to examine, identify and describe the factors that influence the turnover intention of nurses in Croatia.
Methods: A qualitative descriptive phenomenological study was conducted in June 2018. The participants were 20 registered nurses working full time who were employed in different cities in the Republic of Croatia, working in different healthcare institutions and in different medical fields. The data were obtained from interviews and were analysed and interpreted using the content analysis method.
Results: During data analysis, four main ideas emerged as follows: job satisfaction, work motivation, psychological factors (individual) and structural factors ā work environment. Job satisfaction has been identified as a key factor with direct impact in nurses\u27 turnover intention. Work motivation, psychological factors (individual) and structural factors ā work environment does not have a direct influence on the nurses\u27 intention to leave their job, but they have a significant indirect impact through job satisfaction.
Conclusion: Recognizing nursing challenges in the healthcare system and the factors which influence the intention of nurses to leave their workplace can help with the development of a clear strategy and retention measures based on the factors that influence the nursesā turnover intention.
(SmokroviÄ E, Gusar I, HnateÅ”en D, BaÄkov K, Bajan A, GrozdanoviÄ Z, Placento H, Žvanut B. Influence of Work Motivation, Work Environment and Job Satisfaction on Turnover Intention of Croatian Nurses: A Qualitative Study. SEEMEDJ 2019; 3(2); 33-44
Serratus anterior plane blok za analgeziju kod mastektomije
The incidence of breast cancer in women is on the rise, but the survival rate has increased
due to the progress of medicine, especially if the disease is detected early. One of the imperatives is
the patientās quality of life after treatment. Inadequately treated acute postoperative pain leads to a worse
treatment outcome and the development of chronic pain. The incidence of chronic pain after surgical treatment
of breast cancer is high and negatively affects the quality of life of patients in the long term. Serratus
anterior plane block (SAPB) is a relatively new ultrasound-guided regional analgesia technique. SAPB represents
an alternative to an epidural, and to paravertebral and intercostal blocks. This review aims to describe
serratus anterior plane block for breast surgery and emphasize their short- and long-term benefit. For this
review, we searched MEDLINE in November 2022 to identify metanalyses, randomized controlled trial
systemic reviews, and reviews published in the last five years. The search for metanalyses yielded 4 results;
12 results were found for randomized controlled trials; 5 results for reviews; and 4 results for systematic
reviews. When employing SAPB in patients after mastectomy, good analgesia is achieved in the early postoperative
period and the incidence of chronic pain is reduced, thus improving quality of life.Incidencija karcinoma dojke kod žena je u porastu ali napretkom lijeÄenja poveÄana je stopa preživljena naroÄito ako se
bolest otkrije u ranom stadiju. Jedan od imperativa je kvaliteta života bolesnice nakon lijeÄenja. Neadekvatno lijeÄena akutna
poslijeoperacijska bol dovodi do loÅ”ijeg ishoda lijeÄenja i razvoja kroniÄne boli. Incidencija kroniÄne boli nakon operativnog
lijeÄenja karcinoma dojke je visoka i dugoroÄno negativno utjeÄe na kvalitetu života bolesnica. Serratus anterior plane block
(SAPB) je relativno nova ultrazvukom voÄena tehnika regionalne analgezije a predstavlja alternativu epiduralnim, paravertebralnim
i interkostalnim blokovima.Cilj ovog pregleda je opisati serratus anterior plane block za mastektomiju i naglasiti
njegovu kratkoroÄnu i dugoroÄnu korist. Za potrebe ovog rada proveli smo pretragu MEDLINE baze do studenog 2022.
kako bismo identificirali meta-analize, sistemske preglede, randomizirana kontrolirana ispitivanja i preglede objavljene u
posljednjih pet godina. Pretraživanjem meta-analiza dobili smo 4 rezultata, za randomizirano kontrolirano ispitivanje 12
rezultata, za preglede 5 rezultata i za sustavni pregled 4 rezultata.
Primjenom SAPB kod bolesnica nakon mastektomije postiže se dobra analgezija u ranom poslijeoperacijskom periodu
te se smanjuje pojavnost kroniÄne boli i na taj naÄin poboljÅ”ava se kvaliteta života
Utjecaj razliÄitih minimalno invazivnih metoda na ishod lijeÄenja lumbalne radikularne boli
Lumbar radicular pain is a major public health, social and economic problem and is
often the cause of professional disability. The aim of this study was to compare pain intensity, disability
and neuropatic pain depending on the method of treatment (epidural steroid injection or percutaneous
laser disc decompression) in the treatment of lumbar radicular pain caused by intervertebral disc herniation
with or without discoradicular contact. Data were collected from 28 patients at 3 measurement
points (before the procedure and at examinations on the 15th and 30th day after the procedure) using
the Numeric Rating Scale (NRS), Oswestry Disabilitiy Indeks (ODI) and Pain Detect. The reduction of
the pain after the procedure was statistically significant only in the group of patients with discoradicular
contact in whom PLDD was performed (P=0.04). From the obtained results, it can be concluded that percutaneous
laser disc decompression (PLDD) led to a greater reduction in disability (P=0.009) in patients
with discorradicular contact, whereas lumbar transforaminal epidural steroid injection (ESI TF) led to
greater reduction in patients without discorradicular contact (P=0.02). The results indicate that there was
a significant (P=0.01) reduction in neuropathic pain in patients without discorradicular contact who were
treated with ESI TF and in patients with discoradicular contact who were treated with PLDD (P=0.04).Lumbalna radikularna bol je veliki javnozdravstveni, druÅ”tveni i ekonomski problem i Äesto je uzrok profesionalne nesposobnosti.
Cilj ovog istraživanja bio je usporediti intenzitet boli, onesposobljenost i neuropatsku bol ovisno o naÄinu
lijeÄenja (epiduralna injekcija steroida ili perkutana laserska dekompresija diska) u lijeÄenju lumbalne radikularne boli uzrokovane
hernijom intervertebralnog diska sa ili bez diskoradikularnog kontakta. Podaci su prikupljeni od 28 pacijenata u 3
toÄke mjerenja (prije zahvata i na pregledima 15. i 30. dana nakon zahvata) pomoÄu Numeric Rating Scale (NRS), Oswestry
Disabilitiy Indeks (ODI) i Pain Detect. Smanjenje boli nakon zahvata bilo je statistiÄki znaÄajno samo u skupini bolesnika s
diskoradikularnim kontaktom kod kojih je uÄinjen PLDD (p = 0,04). Iz dobivenih rezultata može se zakljuÄiti da je PLDD
doveo do veÄeg smanjenja onesposobljenosti (p = 0,009 ) u bolesnika s diskoradikularnim kontaktom a ESI u bolesnika bez
diskoradikularnog kontakta (p = 0,02 ). Rezultati pokazuju da je doÅ”lo do znaÄajnog (p = 0,01) smanjenja neuropatske boli
u bolesnika bez diskoradikularnog kontakta koji su lijeÄeni ESI i u bolesnika s diskoradikularnim kontaktom koji su lijeÄeni
PLDD (p = 0,04)
Epidemiology of Adult Fractures in Eastern Croatia by Cause of Injury, Fracture Location and Type of Treatment
Th is retrospective study investigated the impact of age on fracture occurrence through the comparison of two patient groups, 17-64 and 64+ age groups. Study data covered all fractures treated at a large hospital in eastern Croatia. A total of 15,519 patients with fractures were treated at the trauma department (inpatient and outpatient), with a total of 17,257 fractures presented, 71% managed as outpatients and 29% as inpatients. A total of 11,046 outpatients were treated for 12,187 fractures and a total of 4473 inpatients were treated for 5070 fractures. Th e group of 17-64-year old males had 5787 fractures, accounting for 34% of all fractures presented. Th e group of 17-64-year old females had 4094 fractures, accounting for 24% of total fractures. Th e group of 65+ year-old males had 2659 fractures, accounting for 15% of all fractures presented and the group of 65+ year-old females presented with 4717 fractures, accounting for 27% of all fractures presented. Th e āfall in levelā was the predominant cause of injury in all patients. Th e characteristics of osteoporotic bone fractures were evident in the population of 65+ females and to a lesser degree in 65+ males. Th e 17-64 age group, both males and females, had more fractures considered as high-energy fractures
Usporedbena radioloÅ”ka dijagnostika akutnih ozljeda trokutastog vezivno-hrskaviÄnog kompleksa
The aim was to analyze patients with clinical diagnosis of triangular fibrocartilage
complex (TFCC) lesion using standard x-ray, ultrasound, conventional magnetic resonance imaging
(MRI) and MR arthrography (MRA); to evaluate the accuracy of MRA compared with MRI in the
diagnosis of this lesion; and to evaluate ultrasound as a method of diagnosing TFCC lesion. We analyzed
72 patients (46 female and 26 male; age range, 22-61 years; mean age 37 years; 50 right and 22
left wrists) with suspected TFCC lesion with clinical examination, standard x-rays, and ultrasound.
We confirmed patients with traumatic TFCC injury on MRI and MRA. Ultrasound found 13 lesions
in 72 patients with suspected TFCC lesions. Conventional MRI found 66 and MRA 68 TFCC lesions.
Ultrasound is useful for visualizing intra-articular effusion, soft tissue, bone surface, and for early
detection of occult fractures. MRI is a better diagnostic modality, fully able to visualize the TFCC
cartilage and ligaments. MRA is consistently and accurately able to visualize structural abnormalities
of TFCC.Cilj istraživanja bio je analizirati bolesnike s dijagnozom ozljede trokutastog vezivno-hrskaviÄnog kompleksa (triangular
fibrocartilage complex, TFCC) pomoÄu standardnih radiograma, ultrazvuka, magnetske rezonancije (MR) i MR artrografije
(MRA); procijeniti vrijednost MRA u usporedbi s MR u dijagnosticiranju ozljeda TFCC; procijeniti vrijednost ultrazvuka
(UZV) kao metode izbora u dijagnosticiranju ozljeda TFCC. Analizirali smo 72 bolesnika (46 žena i 26 muŔkaraca u dobi
od 22-61 godine, srednja dob 37 godina; 50 desnih ruÄnih zglobova i 22 lijeva ruÄna zgloba) s kliniÄkom sumnjom na ozljedu
TFCC pomoÄu standardnih radiograma i UZV. Naposljetku smo potvrdili ozljedu TFCC pomoÄu MR i MRA. UZV je
potvrdio 13 ozljeda od 72 analizirana bolesnika kod kojih se sumnjalo na ozljedu TFCC. Konvencionalna MR ih je potvrdila
66, dok ih je MRA potvrdila 68. ZakljuÄeno je kako je UZV vrijedna metoda za prikaz intraartikularnog izljeva, mekih Äesti,
povrÅ”ine kosti, kao i za ranu dijagnostiku prijeloma koji nisu bili vidljivi standardnim rtg snimkama. MR je bolja dijagnostiÄka
metoda za prikaz struktura, ali za pouzdan i toÄan prikaz TFCC i pripadajuÄih patoloÅ”kih traumatskih promjena metoda
izbora je MRA
Quality of Life and Mental Distress in Patients with Chronic Low Back Pain: A Cross-Sectional Study
The aim of this study was to examine the levels of health-related quality of life (HRQoL), pain intensity, and mental distress in participants with chronic low back pain (CLBP), and to examine the differences in the HRQoL of participants with respect to mental distress and the correlations of the examined variables. Data were collected from 148 patients using the SF-36 Health Status Questionnaire (SF-36), the Clinical Outcomes in Routine Evaluation–Outcome Measure (CORE-OM) questionnaire, and the visual-analog pain scale (VAS). The results indicate poorer self-assessment of physical health (Me = 28.1) compared to mental health (Me = 39.4). Participants with higher levels of mental distress reported significant emotional limitations (p = 0.003), lower energy (p < 0.001), poorer psychological health (p < 0.001) and social functioning (p < 0.001), more pain (p = 0.007), and, ultimately, poorer general health (p < 0.001). The level of mental distress was related to the level of HRQoL, while a correlation with the level of pain of the participants was not found. The study results indicate a connection between the presence of mental distress and almost all aspects of HRQoL in participants with CLBP