LEAN OPERATIONS IMPLEMENTATION IN SALES COMPANY

Racionalno poslovanja naglašava minimiziranje količine resursa koji se koriste u raznim aktivnostima kompanije i uključuje identificiranje i eliminiranje aktivnosti koje ne donose vrijednost. Filozofija racionalnog poslovanja uključuje načela i praksu smanjivanja troškova uklanjanjem “otpada” i pojednostavljenjem svih aktivnosti kompanije. Postoji sedam vrsta tradicionalnih otpada u aktivnostima kompanije i više od desetak alata za njihovo uklanjanje. U postizanju filozofi je racionalnog poslovanja pet je glavnih koraka koji označuju životni ciklus racionalne proizvodnje. Racionalno poslovanje i filozofi ja racionalnog poslovanja omogućuju kompanijama da budu bolje, brže, njihovi proizvodi i/ili usluge jeftinije, a one same privlačnije kupcima. Tranzicija, prema racionalnom poslovanju, nije jednostavna i jednokratna nego je to neprekidno djelovanje prema usavršavanju poslovanja kompanije. Rad se sastoji od dva dijela. U prvom dijelu promatra se racionalno poslovanje (definicija, teorijski okvir i alati racionalnog poslovanja), a u drugom dijelu se daje primjer primjene racionalnog poslovanja u Republici Hrvatskoj u prodajnoj tvrtki i njegov utjecaj povećanja učinkovitosti poslovanja.Lean thinking states minimization of resource amount that are used in different company activities and includes identifying and elimination of activities that do not add value. Lean thinking philosophy includes principles and practice of cost cutting through “waste” elimination and simplifying all companies’ activities. There are seven traditional wastes and more than ten different tools for their elimination. In reaching lean thinking philosophy there are five main steps that mark life cycle or lean production. Lean thinking and lean thinking philosophy allow companies to be better, faster, their products and/or services cheaper, and more attractive to their buyers. Transition from “normal” to lean company is not simple and one-time activity. It is ongoing work for company’s business efficiency improvement. Paper consists from two parts. In first part definitions and theoretical frame of lean thinking is given, while in the second part we gave an example of lean operations implementation in Croatia and how lean operations can influence on improving efficiency of company

Ageism: Does it Exist Among Children?

Ageism is stereotyping and prejudice against individuals or groups because of their age. Robert Butler first used it in 1969, to express a systematic stereotyping and discrimination against elderly people. Available data appears to confirm that attitudes of children to the old age differ from that of adults. The study population consisted of 162 subjects (56 school children, 48 nurses and 58 elderly patients). Each subject in the survey was asked to respond to the following three questions: Question #1: “Is the old age unattractive ?”; Question #2: “How old is an old man? Question #3: “What should you do to have a long life (what is good for longevity)? The majority of polled children (33) gave positive statements about ageing in their responses to the first item, while most of the nurses gave condition answers, like: “It is not unattractive if you are healthy”. Elderly subjects made up a group with the majority of negative responses (in percentage), as only 33% of them answered that old age is not unattractive. All three groups of subjects demonstrated a good knowledge of what is considered good for longevity, and had a generally positive health attitude. Our results indicate that majority of children have positive perception and attitude about old age, which leads us to conclusion that ageism is adopted later in life

Health-related quality of life in elderly patients hospitalized with chronic heart failure

Background: Chronic heart failure is a very common condition in the elderly, characterized not only by high mortality rates, but also by a strong impact on health-related quality of life (HRQOL). Previous studies of HRQOL in elderly heart failure subjects have included mostly outpatients, and little is known about determinants of HRQOL in hospitalized elderly population, especially in Serbia. In this study, we tried to identify factors that influence HRQOL in elderly patients hospitalized with chronic heart failure in Serbia. Methods: The study population consisted of 136 patients aged 65 years or older hospitalized for chronic heart failure. HRQOL was assessed using the Minnesota Living with Heart Failure questionnaire. Predictors of HRQOL were identified by multiple linear regression analysis. Results: Univariate analysis showed that patients with lower income, a longer history of chronic heart failure, and longer length of hospital stay, as well as those receiving aldosterone antagonists and digoxin, taking multiple medications, in a higher NYHA class, and showing signs of depression and cognitive impairment had significantly worse HRQOL. Presence of depressive symptoms (P lt 0.001), higher NYHA class (P=0.021), lower income (P=0.029), and longer duration of heart failure (P=0.049) were independent predictors of poor HRQOL. Conclusion: Depressive symptoms, higher NYHA class, lower income, and longer duration of chronic heart failure are independent predictors of poor HRQOL in elderly patients hospitalized with chronic heart failure in Serbia. Further, there is an association between multiple medication usage and poor HRQOL, as well as a negative impact of cognitive impairment on HRQOL. Hence, measures should be implemented to identify such patients, especially those with depressive symptoms, and appropriate interventions undertaken in order to improve their HRQOL

Health-related quality of life in elderly patients hospitalized with chronic heart failure

Background: Chronic heart failure is a very common condition in the elderly, characterized not only by high mortality rates, but also by a strong impact on health-related quality of life (HRQOL). Previous studies of HRQOL in elderly heart failure subjects have included mostly outpatients, and little is known about determinants of HRQOL in hospitalized elderly population, especially in Serbia. In this study, we tried to identify factors that influence HRQOL in elderly patients hospitalized with chronic heart failure in Serbia. Methods: The study population consisted of 136 patients aged 65 years or older hospitalized for chronic heart failure. HRQOL was assessed using the Minnesota Living with Heart Failure questionnaire. Predictors of HRQOL were identified by multiple linear regression analysis. Results: Univariate analysis showed that patients with lower income, a longer history of chronic heart failure, and longer length of hospital stay, as well as those receiving aldosterone antagonists and digoxin, taking multiple medications, in a higher NYHA class, and showing signs of depression and cognitive impairment had significantly worse HRQOL. Presence of depressive symptoms (P<0.001), higher NYHA class (P=0.021), lower income (P=0.029), and longer duration of heart failure (P=0.049) were independent predictors of poor HRQOL. Conclusion: Depressive symptoms, higher NYHA class, lower income, and longer duration of chronic heart failure are independent predictors of poor HRQOL in elderly patients hospitalized with chronic heart failure in Serbia. Further, there is an association between multiple medication usage and poor HRQOL, as well as a negative impact of cognitive impairment on HRQOL. Hence, measures should be implemented to identify such patients, especially those with depressive symptoms, and appropriate interventions undertaken in order to improve their HRQOL.publishedVersio

Declaration on eHealth. 1 st Revision

The Croatian Academy of Medical Sciences (CAMS) has published this "Declaration on eHealth" to warn all stakeholders (patients, health professionals, institutions, government agencies, suppliers) to use the huge potential of information and communication technologies (ICT) and solutions to improve health care in Croatia. The Declaration draws attention to areas of infrastructure such as: education, regulation and standardization, medical and health informatics (MHI) as a profession, the obligation of institutions, government bodies and suppliers. In addition to answering the question "what?", the Declaration addresses the most important question "how?". Instead of the existing "atomization" and disconnection of projects and solutions, the Declaration proposes the realization of a common concept of computerization in health and for health by establishing a central body at the state level (agency, office, institute, etc.) in which expertise, decision-making and financing of health informatics projects at the national level will be concentrated. The central body should function on the principles of professionalism, independence and transparency. The purpose of the proposal offered by the Declaration is to improve the management of health system computerization, which would avoid containment within institutions, enable obtaining and purposeful use of available financial resources and experts, and achieve the necessary cooperation, which would bring the results in ICT support to the health system

Guidelines for the Advancement of Electronic Health Records

The Guidelines have been proposed for the development of electronic health records (EHR) that must meet the needs of all relevant stakeholders. The system of electronic health records should contribute to the improvement of health services to healthcare users, support the daily work of health professionals and enable continuous improvement of quality at all levels of the health care system. The following concepts are defined: electronic health record, electronic medical record (EMR) and electronic personal health record (EpHR); Any health care user should have one EHR, one EpHR, and multiple EMRs. The parts of the EHR, i.e., the EMR and EpHR, should not be physically kept in the same place, but must be interconnected in case of need (via the health care user unique identification and authentication rules). All EMRs contain data collected by health professionals in health facilities (primary health care, polyclinics, hospitals, public health institutes, etc.). This data can be entered directly or transmitted from medical devices. The EpHR contains data collected and maintained by the health care user. They can be recorded directly or transmitted from a medical device. Data in the EHR may be made available to authorized persons only. Data protection in the EHR should be ensured in three ways: technically, regulatory and through codes of ethics, in line with international initiatives (certification, EU regulations, standards, etc.). The EHR and its components should be used for both primary and secondary purposes. The primary use of the data relates to the individual (diagnosis, therapy, vaccination, etc.). The secondary use relates to population groups (reporting on the health status of the population, the quality of health care, the effects of preventive activities, funding, and research, etc.). The EHR data (structured or not) should be defined by health care professional associations. The ICT experts need to offer optimal technological solutions. The EHR development strategy, as well as supervision (medical, legal, technical, and ethical aspects, as well as standardization) should be entrusted to the institution at the national level, i.e., the Central eHealth Authority. EHR (EMR and EpHR) should be developed in stages, step by step, depending on current knowledge, technology, and material resources

GUIDELINES FOR THE ADVANCEMENTS OF ELECTRONIC HEALTH RECORDS

U radu je opisan pravac djelovanja u izgradnji sustava elektroničkih zdravstvenih zapisa koji će zadovoljiti potrebe svih dionika zdravstvene zaštite, podržati zdravstveno-profesionalni rad i omogućiti kontinuirano unaprjeđivanje kvalitete na svim razinama i u svim segmentima zdravstvene zaštite te na taj način doprinijeti očuvanju i poboljšanju zdravlja svih korisnika zdravstvene zaštite.Defi nirani su pojmovi: • elektronički zdravstveni zapis (EZZ) i njegovi dijelovi • elektronički medicinski zapis (EMZ) • elektronički osobni zdravstveni zapis (EoZZ) pri čemu svaki korisnik zdravstvene zaštite ima jedan EZZ, jedan EoZZ i više EMZ-ova. Pojedini dijelovi EZZ-a ne moraju biti fizički na istom mjestu, ali se moraju moći povezati preko identifi kacijskog atributa korisnika zdravstvene zaštite i određenih pravila autentifi kacije. Pojedini EMZ sadrži podatke koji se prikupljaju na zdravstvenim radilištima (PZZ, SKZZ, bolnice, javnozdravstvena radilišta i sl.), a prikupljaju ih zdravstveni profesionalci, direktnim upisom ili prijenosom iz uređaja koji te podatke proizvode. EoZZ sadrži podatke koje prikuplja i s njima raspolaže korisnik zdravstvene zaštite. Ti se podatci unose direktno ili prenose iz uređaja koji te podatke proizvode. Podatci iz EZZ-a moraju biti dostupni isključivo ovlaštenim osobama. Propisima treba defi nirati pojam ovlaštene osobe. Zaštitu podataka u EZZ-u treba osiguravati tehnički, propisima i etičkim kodeksima, usklađeno s međunarodnim inicijativama (certifi kacija, EU uredbe, norme i sl). EZZ i njegovi dijelovi moraju udovoljiti i primarnoj i sekundarnoj uporabi, pri čemu se primarna uporaba odnosi na pojedinca (dijagnostika, terapija, cijepljenje, zdravstvena njega i sl.), a sekundarna na skupine, tj. populaciju u skrbi, unaprjeđenje kvalitete rada u zdravstvu, učinke preventivnih aktivnosti, fi nanciranje i istraživanja. Sadržaj i oblik podataka u EZZ-u trebaju defi nirati stručne udruge zdravstvenih profesija, a IKT profesionalci iznalaziti primjerena tehnološka rješenja. Strategiju i izgradnju EZZ-a kao i nadzor sa svih aspekata treba povjeriti krovnoj instituciji koja djeluje na nacionalnoj razini. Unaprjeđivanje EZZ-a treba se odvijati u fazama, u skladu s postojećim znanjima, tehnološkim novinama i materijalnim mogućnostima.The course of action to build electronic health records able to meet health stakeholder needs is described. The electronic health record system should contribute to improvement of service for all healthcare users by supporting daily work of healthcare professionals and enabling continuous quality improvement at all healthcare levels. The electronic health record (EHR), electronic medical record (EMR) and electronic personal health record (EpHR) have been defi ned; every healthcare user should have one EHR, one EpHR and several EMRs. The EHR parts, i.e. EMRs and EpHR, should not be kept at the same place physically, but they must be linked together (by use of identifi cation attributes of the healthcare user and certain authentication rules). Particular EMRs contain data collected at healthcare settings (primary healthcare, specialistconsultant health care, hospitals, public health settings, etc.) by health professionals. These data can be entered directly or by transfer from medical devices producing them. The EpHR contains data collected and maintained by the healthcare user. They can be entered directly or transmitted from the devices producing them. The EHR data should be made accessible to authorized persons only. Data protection in EHR should be provided through technical, regulatory and ethical codes, in line with international initiatives (certifi cation, EU regulations, standards, etc.). The EHR and its components should be used for both primary and secondary purpose. Primary use of EHR data refers to individual subjects (diagnosis, therapy, vaccination, etc.). Secondary use refers to population groups (reporting health status of the population, quality of healthcare, effects of preventive activities, funding, and research). The EHR data (structured or not) should be defi ned by associations of health professionals. The ICT professionals should be able to fi nd appropriate technological solutions. The EHR development strategy, as well as surveillance (medical, legal, technical and ethical points of view, as well as standardization) should be delegated to an institution at the national level. The EHR (EMR and EpHR) should be deployed in phases, step by step, depending on the current knowledge, technology, and material resources

Factors that influence quality of life in elderly patients with chronic heart failure

Увод: Хронична срчана инсуфицијенција (ХСИ) је веома често обољење у старих и одликује се не само високим морталитетом, већ и јаким негативним утицајем на квалитет живота повезан са здрављем (КЖПЗ). Претходне студије о квалитету живота у ХСИ су углавном испитивале млађе болеснике, тако да се мало зна о факторима који утичу на КЖПЗ код старијих пацијената са ХСИ. Циљеви: Циљ ове студије је да утврди социодемографске (године, пол, образовање, брачни статус, приходи) и клиничке факторе (NYHA класа, ејекциона фракција леве коморе, терапија, депресивност, когнитивни статус) који утичу на квалитет живота код старијих болесника са хроничном срчаном инсуфицијенцијом. Методе: Студија је обухватила 200 хоспитализованих болесника са ХСИ старих 65 или више година. КЖПЗ је процењен Минесота упитником „Живети са слабим срцем". Независни предиктори квалитета живота су утврђени мултиплом линеарном регресионом анализом. Резултати: Лошији квалитет живота су имали болесници са нижим приходима, дужим трајањем ХСИ, дужом хоспитализацијом, они који су узимали диуретике, антагонисте алдостерона, дигоксин и већи број лекова, затим пацијенти у вишој NYHA класи и са већим бројем симптома, као и они који су показивали знаке депресије и когнитивног дефицита. Независни предиктори лошијег квалитета живота су били: већи број бодова на Хамилтоновој скали за депресију (Sβ=0,579; p<0,001), виша NYHA класа (Sβ=0,236; p<0,001) и већи број симптома (Sβ=0,163; p=0,003). Закључак: Независни предиктори лошијег квалитета живота код старијих болесника са ХСИ су већи број бодова на Хамилтоновој скали за депресију, виша NYHA класа и већи број симптома. Поред тога, пронашли смо да постоји значајна повезаност између узимања већег броја лекова и лошијег квалитета живота, као и негативан утицај когнитивног дефицита на КЖПЗ. Имајући то у виду, потребно је идентификовати такве болеснике, посебно оне са депресивним симптомима, и предузети одговарајуће мере у циљу побољшања њиховог квалитета живота.Background: Chronic heart failure is a very common condition in the elderly, characterized not only by high mortality rates, but also by a strong negative impact on health-related quality of life (HRQOL). Previous studies of HRQOL in elderly heart failure subjects have included mostly younger patients, and little is known about determinants of HRQOL in elderly population. Objectives: The aim of this study was to determine socio-demografic (age, sex, education, marital status, income) and clinical factors (NYHA class, left ventricular ejection fraction, medication, depression, cognitive status) that influence HRQOL in elderly patients with chronic heart failure. Methods: The study population consisted of 200 patients aged 65 years or older hospitalized for chronic heart failure. HRQOL was assessed using the Minnesota Living with Heart Failure questionnaire. Predictors of HRQOL were identified by multiple linear regression analysis. Results: Patients with lower income, a longer history of chronic heart failure, and longer length of hospital stay, as well as those receiving diuretics, aldosterone antagonists and digoxin, taking multiple medications, in a higher NYHA class, with a greater number symptoms, and showing signs of depression and cognitive impairment had significantly worse HRQOL. Higher score on Hamilton Depression Rating Scale (Sβ=0.579; p<0.001), higher NYHA class (Sβ=0.236; p<0.001), and greater number of symptoms (Sβ=0.163; p=0.003) were independent predictors of poor HRQOL. Conclusion: Higher score on Hamilton Depression Rating Scale, higher NYHA class, and greater number of symptoms are independent predictors of poor HRQOL in elderly patients with CHF. Further, there is an association between multiple medication usage and poor HRQOL, as well as a negative impact of cognitive impairment on HRQOL. Hence, measures should be implemented to identify such patients, especially those with depressive symptoms, and appropriate interventions undertaken in order to improve their HRQOL

Articles on elderly in Serbian medical journals

Introduction Population aging is a feature of all countries in the world. According to statistics, the Republic of Serbia is one of the countries with the majority of the elderly. Taking this into account, are articles on the elderly well represented in domestic medical journals? Objective The aim of the paper was to determine whether there was a sufficient number of articles on the elderly in domestic medical journals. Methods The articles on the elderly were searched using search engines in domestic and foreign medical journals for the last 5 years compared with the number of articles on children in the same publications for the same period. Results In the Serbian Citation Index, 11 articles on the topic of the elderly, and 487 on children were registered. In Srpski arhiv za celokupno lekarstvo, there was registered only one article on the topic of the elderly, and 30 on children. In Vojnosanitetski pregled, 2 articles on the elderly and 13 on children were registered (p&lt;0001). For the last five years, in the New England Journal of Medicine, there were 593 articles on the elderly and 759 articles on children; in the JAMA, there were 63 articles on the elderly and 303 articles on children; and in The Lancet, in the last five years, 46 articles on the elderly and 148 articles on children were published. Conclusion The themes of the elderly were rarely represented in Serbian medical journals. This has reduced the interest of physicians in medical problems of this growing population of patients and further sent them away from making standards in the diagnosis and treatment of the elderly