Quality control on ERC advanced life: Support courses in Serbia and Europe: Preliminary data, original research

Aim Affirm through the survey, the satisfaction of the participants of ERC ALS courses in Serbia and compare the collected data from previous years to the data about quality of the courses from the other countries. Method: The processed data were gathered in CMS system, included preparation of the courses, the reports of the course director and evaluation questionnaires that have been filled in by the seminar attendants. Twelve questions that are related to the organization and performance of ALS seminary have been processed. The criteria for inclusion was that at least one ERC ALS seminary has been held in the country, that has been a part of this survey, and that the organizer has enabled evaluation by the presence of an participants e-mail addresses. Results: Results implicate data collected in 37 countries, where ERC ALS courses took place in first five months of the year, and contain internet addresses of the participants. Seventeen of them have complete data. The number of ERC ALS training course is 1.02/100.000 inhabitants, with minimal value of 0.11/100.000 inhabitants in Italy, to the maximum value 8.44/100.000 inhabitants in Denmark. It's 2.81/100.000 in Serbia. The average number of organized ERC ALS courses is 0.83/1.000.000 inhabitants and the lowest is in Turkey, where upon 1.000.000 residents, 0.05 courses were organized. The highest number of organized training courses has taken place in Denmark, with the number of 5.53 courses upon million habitants. Serbia has arranged 2.81 course upon one million residents, where the activity and the agility of the course organizer has been graded with an excellent mark. The Egypt's attendants valuated -100% the usefulness of the course content with the highest grade. The Dutch were the least satisfied with the content of the course, and their result is just above the figure of 87%. Right behind them are the Italians, Slovenians, Finns, Swedish placed. In Serbia, the grade is 96.49% and is among the best in Europe. Training course will be recommended 100% by the Serbian attendants. Conclusion The change of the performance and the method of work of the course, human resource renewal brought the new quality in presentation the ERC training in Serbia. Young and enthusiastic instructors, significantly contributed with the enthusiasm, enjoyable and regular method of presentation, so the seminary ERC ALS can get one of the highest grades in Europe, in fact, the highest mark according to the satisfaction of the attendants

Implementation analysis of the guidelines from 2015

Aim: Implementation analysis of the guidelines from 2015 among physicians, through the interpretation of the results obtained in a given scenario. Method: The research included 250 physicians from Serbia who were introduced to the scenario they should have solved on their own as a part of resuscitation team. List for evaluating the quality of the intervention made by The European Resuscitation Council was used for the analysis. Results: During the handover and monitoring insight, the cardiac frequency and tension (89.6%) was not checked in a high percentage. There is no specially established team for resuscitation and as such is not recognized nor there are any training that is carried out for that purpose. There is no adequate equipment containing prompt feedback, during the implementation of resuscitation techniques, as recommended from the 2015. There are no devices that record the quality of work and quality of implementation of measures during the implementation of two minutes CPR. Evaluating and checking the quality of the work in performing resuscitation measures, is not possible. During resuscitation, oxygen is often used in hospital conditions (55.7%) than applied in the prehospital (22.3%). The practice of applying supraglottic devices is very low, in both, the prehospital (16.5%) and at the hospital level (10.2%). Monitoring of the patient is performed through the patient cable or defibrillator paddles. When therapy is applied, there is still use of Atropine in nonshockable rhythm, more often in hospital conditions (31.2%). It's not possible to note a quality of compression during CPR or the amount of a supplied air. Because there is no use of adhesive defibrillation electrodes, there is no option to minimize the period of compression. Conclusion: Physicians in Serbia are not sufficiently familiar with the protocols of 2015 and it is necessary to implement that protocols. Applying of the equipment and drugs standards would drastically improve quality of the implementation and evaluation in resuscitation procedure

The European Resuscitation Council courses in Serbia year 2016.

Aim: The aim of this study is analysis of The European Resuscitation Council courses for a six-month period in 2016. Methods: The data collected in the CMS system on the Preparation courses were analysed for the period from January to June 2016. Results: Analysis of implemented and organized The European Resuscitation Council courses, were showed that the greatest number of times-32, held the course Basic Life Support with the use of automatic external defibrillators - BLS/AED provider course, during which were trained 318 participants. Courses were engaged 45 trainers and 8 Course Director. The next most frequent organization of courses are Advanced Life Support- ALS provider with 13 courses held and Immediate Life Support- ILS with 12 courses in the six-month period. At ILS courses trained more participants- 178, Unlike ALS course where attended and passed the 146 participants. ALS provider courses attended 32 instructors while the ILS provider hired 24 instructors. At ALS provider courses and ILS provider engaged by an identical number for each course director-7. During year 2016, the instructor courses had been organized and implemented. Four BLS / AED instructor and 3 Generic instructor training. Total had been implemented 65 courses attended and passed by 706 participants. Conclusion: In just half a year, a number on courses have been conducted by Serbian Resuscitation Council. Although, legally binding standards for taking care of life-threatened patients under protocols don't exist, except those accredited by health organizations, large number of starters are motivated to attend the courses. Long term following is necessary so that the activity trend from Serbian Resuscitation Council can be determined as well as response of starters to attend the courses

EURECA 2015: Serbia

Aim: Analysis of occurrence, treatment and outcome of cardiac arrest through the conducted study EuReCa 2015 in Republic of Serbia. Method: Data have been collected in EMS throughout 2015, that have been part of Prospective observational trial of the European Resuscitation Council registered in the trial database - NCT02236819 and approved by health authorities in USA. The study has included all patients - both adults and children, who were found dead in outpatient circumstances, and intervened by the emergency medical service. Data have been collected during a one-year period in 2015. The surveys were carried out after the intervention by the physician. Results: Study includes population of 853.500 inhabitants. Cardiac arrest in 2015 has been affirmed on the territory of Republic of Serbia,1366 times in 2015, specifically 160 on 100.000 inhabitants. Cardiopulmonary resuscitation measures were initiated at 540 patients, that is to say 63,3/100.000 residents. The most common etiological cause of OHCA is cardiological, in 233 cases. The most common place of occurrence of OHCA is at home, in 410 cases. Sixteen times, the dispatcher that receives the emergency calls, has guided the CPR through the telephone. The OHCA has been witnessed by the bystander even 388 times, but the CPR has been initiated by the bystander only 43 times (5,0/100.000). Before the arrival of EMS, AED hasn't been used or attached, not even once. ROSC has been achieved at 92 (10,78/100.000) patients. The number of patients that have been hospitalized with ROSC is 76 (8,9/100.000). The number of patients that have been discharged from hospital is 23 (2,7/100.000). After 30 days of discharge from hospital, 22 patients were alive (2,6/100.000). Conclusion: Prior notices of insufficient involvement of the citizens, bystanders, as well as their cooperation with the dispatchers, and the possibility of telephone guidance of CPR, leads us to the motivation of the employees for conducting the number of various activities in raising the conscience of the citizens and their important role as a bystander. However, it's necessary to monitor out of hospital cardiac arrest, which will allow complex analysis incidence and the survival rate on territory of Republic of Serbia

EURECA One 2014: One-month data collection in the municipality of Subotica

Heart disease is the underlying cause in two thirds of outpatient cardiac arrests. Sudden cardiac arrest occurs in people with no previous confirmed cardiac disease and occurs in situations where is possible presence of eyewitnesses. In this situations the cooperation of witnesses is necessary. It is not rare that news appear in the media, as well as on social networks footage of young athletes and public figures who suddenly lost consciousness on the sports field or at work. Despite the few studies that deal with this issue, in the literature can be found data indicating that a significantly better outcome after a sudden cardiac arrest if the arrest happens at work than in any other place. The inclusion in the study EuReCa One 2014 European resuscitation Council organized by Resuscitation Council of Serbia, the first time we have got relevant information in this field for our region. METHOD A prospective study to collect data on a single questionnaire in the time period time from 1st to 31st October 2014 in the municipality of Subotica. The study included all patients recorded a sudden cardiac arrest out of hospital and intervened medical service. RESULTS Cardiac arrest was confirmed in case of 9 patients by emergency medical services during the month of October 2014 - The incidence of 6.35 / 100,000. From 9 confirmed cardiac arrests 8 are received as a first line of emergency, and 1 as the second row of urgency. Cardiopulmonary resuscitation were started in 8 ( 89 % of all patients are a medical emergency witnessed cardiac arrest ). The incidence of 5.65 per 100.000 inhabitants. Presumed cardiac cause of cardiac arrest preceded in all 9 patients. The incidence of cardiac cause is 6.35 / 100,000 patients. When the witness was present, resuscitation measures are started at 6 ( 75%), or 23.4 / 100,000 patients, however, no resuscitation was not initiated by the laity but exclusively by the Emergency Medical Service after the arrival of the intervention. Ventricular fibrillation or pulseless ventricular tachycardia were observed in 3 patients ( 37.5 % ) or at 2.12 / 100,000 as the first rhythm. Return of spontaneous circulation (ROSC ) was found in 2 ( 25% ) or 1:41 / 100.000. Discharge determined for a patient which represents an incidence of 0.71 / 100,000 inhabitants. One patient has survived after one month observation or 0.71 / 100,000 inhabitants. Conclusion: Collection of data in one month is too short period of time and it is impossible to draw conclusions about the outcome of sudden cardiac arrest in our community, because of the small research sample. It is necessary to continue with data collection. After long-term observations we can expect results that will contribute to improving the quality of work of our institution in the management of patients with sudden cardiac arrest

EuReCa ONE—27 Nations, ONE Europe, ONE Registry A prospective one month analysis of out-of-hospital cardiac arrest outcomes in 27 countries in Europe

AbstractIntroductionThe aim of the EuReCa ONE study was to determine the incidence, process, and outcome for out of hospital cardiac arrest (OHCA) throughout Europe.MethodsThis was an international, prospective, multi-centre one-month study. Patients who suffered an OHCA during October 2014 who were attended and/or treated by an Emergency Medical Service (EMS) were eligible for inclusion in the study. Data were extracted from national, regional or local registries.ResultsData on 10,682 confirmed OHCAs from 248 regions in 27 countries, covering an estimated population of 174 million. In 7146 (66%) cases, CPR was started by a bystander or by the EMS. The incidence of CPR attempts ranged from 19.0 to 104.0 per 100,000 population per year. 1735 had ROSC on arrival at hospital (25.2%), Overall, 662/6414 (10.3%) in all cases with CPR attempted survived for at least 30 days or to hospital discharge.ConclusionThe results of EuReCa ONE highlight that OHCA is still a major public health problem accounting for a substantial number of deaths in Europe.EuReCa ONE very clearly demonstrates marked differences in the processes for data collection and reported outcomes following OHCA all over Europe. Using these data and analyses, different countries, regions, systems, and concepts can benchmark themselves and may learn from each other to further improve survival following one of our major health care events

Frontex - agencija za upravljanje in operativno sodelovanje na zunanjih mejah držav članic : diplomsko delo

Z diplomsko nalogo bom poskušal predstaviti cilje in namen vzpostavitve Evropske agencije za upravljanje in operativno sodelovanje na zunanjih mejah držav članic, oblike policijskega sodelovanje za dosego teh ciljev, praktične izkušnje, ki jih ima Republika Slovenija pri sodelovanju z agencijo FRONTEX, morebitne predloge za odpravo težav in nove oblike sodelovanja. Slovenska policija od samega začetka delovanja agencije FRONTEX in pred tem aktivno sodeluje z različnimi centri, ki so delovali kot predhodnica agencije, si je v tem času nabrala kar nekaj izkušenj. Tako imamo na sami agenciji od leta 2007 permanentno napotene mejne policijske strokovnjake, aktivno sodelujemo pri izdelavi priročnikov, ki so namenjeni mejnim policistom, na meji z Republiko Hrvaško delujejo trije FP uradi, Slovenski policisti sodelujejo v skupnih operacijah v državah članicah, skupne operacije potekajo tudi na območju Republike Slovenije. Slovenska policija sodeluje skupaj z italijanskimi varnostnimi organi v evropski mreži patruljiranja na Jadranskem morju. Prav tako slovenski policijski strokovnjaki aktivno sodelujejo pri pripravi programa za odkrivanje zlorab listin. Z diplomsko nalogo bom prav tako poskušal skozi pregled delovanja in oceno doseženega poskušal odgovoriti na vprašanje, ali agencija Frontex svoje aktivnosti izvaja v skladu s svojo ustanovitvijo, ali je pri tem dovolj uspešna, ali njeno delovanje pomeni tudi boljši nadzor in večjo varnost na zunanji meji Evropske unije.The diploma thesis tries to introduce the goals and purpose of implementation of European Agency for the Management of Operational Cooperation at the External Borders of the Member States, forms of police cooperation to achieve these goals, practical experience the Republic of Slovenia has gained in cooperation with the Frontex agency. Furthermore, the thesis presents some suggestions in order to eliminate problems and some new forms of participation. The Slovenian National Police has been involved with the Frontex agency since the very beginning but it had also been involved with various centres active before the agency was established. Since 2007 we have had some permanent border police experts and have helped in preparing manuals that are meant for police officers on borders. We have three FD offices on the boarder with Croatia. Slovenian police officers take part in joint operations in member states but some of them are also carried out on our territory. The Slovenian National Police cooperates with Italian security authorities in patrolling along the Adriatic Sea. The Slovenian police experts are active in preparing programmes for detection and abuse of documents. The purpose of the thesis is also to answer some of the following questions: has the agency Frontex been implementing all its activities in accordance with its establishment, has it been successful and do its operations lead to a better control and bigger security at the external borders of the European Union

EURECA Serbia One 2014: Cardiopulmonary resuscitation by bystander

INTRODUCTION: Cardiopulmonary resuscitation initiated by witnesses before EMS responding is related with increased survival rate in out of hospital cardiac arrest cases. AIM: Investigating the incidence of basic life support measures provided by layman witnesses before EMS arrival in out of hospital cardiac arrest OHCA cases. METHOD: Prospective, observational study. The data were used from a single data base of Clinical Trials ID: NCT02236819 - Eureca ONE 2014. which is available at www.eureca.rs RESULTS: 1677 (63,31/100 000) cardiac arrests have been entered in this single registry, and in 534 (20,16/100 000) of all EMS provided CPR. Layman witnessed the patient collapse in 64,79% (N=346; n=13,78/100 000) of all cases, and started basic life support measures before EMS arrival in 7,11% (N=38; 1,43/100 000). 38 cardiac arrests with initiated basic life support by bystanders were analyzed: conventional CPR was conducted in 27 patients (5,47/100 000), and only chest compressions (only hand CPR) were used in 11 cases (2,27/100 000). Heart condition was presumed to be the etiological factor in 35 patients (1,32/100 000), respiratory failure in 1 (0,04/100 000), and in 2 cases etiological factor wasn't recorded. OHCA happened mostly at patient's home =31 (1.17/100 000), in the street =3 (0,62/100 000), at public institutions -3 (0,62/100 000), at elderly care facilities -1 (0,04/100 000). Initial shockable rhythm was recorded 4 times, and non-shockable 34. ROSC was achieved 6 times (0,23/100 000), and 6 patients (0,23/100 000) were transported to hospital with positive vitals. One month survival was recorded in 2 cases (0,08/100 000). CONCLUSION: Citizens' involvement in initiation of cardiopulmonary resuscitation of OHCA victims before EMS arrival is of great importance, but in practice the use of this link in the chain of survival is unsatisfactory in our country

Lack of pollinators selects for increased selfing, restricted gene flow and resource allocation in the rare Mediterranean sage Salvia brachyodon

Abstract Range contraction and habitat fragmentation can cause biodiversity loss by creating conditions that directly or indirectly affect the survival of plant populations. Fragmented habitats can alter pollinator guilds and impact their behavior, which may result in pollen/pollinator limitation and selection for increased selfing as a mechanism for reproductive assurance. We used Salvia brachyodon, a narrowly distributed and endangered sage from eastern Adriatic, to test the consequences of range contraction and habitat fragmentation. Molecular data indicate a severe and relatively recent species range reduction. While one population is reproductively almost completely isolated, moderate gene flow has been detected between the remaining two populations. The high pollen-to-ovule ratio and the results of controlled hand pollination indicate that S. brachyodon has a mixed mating system. Quantitative and qualitative differences in the community and behaviour of flower visitors resulted in limited pollination services in one population where no effective pollinator other than pollen and nectar robbers were observed. In this population, self-pollination predominated over cross-pollination. Various environmental factors, in which plant-pollinator interactions play a pivotal role, have likely created selection pressures that have led to genetic and phenotypic differentiation and different resource allocation strategies among populations

Lack of pollinators selects for increased selfing, restricted gene flow and resource allocation in the rare Mediterranean sage Salvia brachyodon

Range contraction and habitat fragmentation can cause biodiversity loss by creating conditions that directly or indirectly affect the survival of plant populations. Fragmented habitats can alter pollinator guilds and impact their behavior, which may result in pollen/pollinator limitation and selection for increased selfing as a mechanism for reproductive assurance. We used Salvia brachyodon, a narrowly distributed and endangered sage from eastern Adriatic, to test the consequences of range contraction and habitat fragmentation. Molecular data indicate a severe and relatively recent species range reduction. While one population is reproductively almost completely isolated, moderate gene flow has been detected between the remaining two populations. The high pollen-to-ovule ratio and the results of controlled hand pollination indicate that S. brachyodon has a mixed mating system. Quantitative and qualitative differences in the community and behaviour of flower visitors resulted in limited pollination services in one population where no effective pollinator other than pollen and nectar robbers were observed. In this population, self-pollination predominated over cross-pollination. Various environmental factors, in which plant-pollinator interactions play a pivotal role, have likely created selection pressures that have led to genetic and phenotypic differentiation and different resource allocation strategies among populations.This publication is based upon work from COST Action An integrated approach to conservation of threatened plants for the 21st Century, ConservePlants CA18201, supported by COST (European Cooperation in Science and Technology), bilateral grants between the Republics of Slovenia and Montenegro BI–ME/18-20-005, and by the project Research and Development of Plant Genetic Resources for Sustainable Agriculture, Centre of Excellence for Biodiversity and Molecular Plant Breeding (CoE CroP-BioDiv), Zagreb, Croatia.Abstract Introduction Results Population genetic structuring and gene flow Flower life-span and sexual functioning Floral rewards Mating system, pollen limitation and pollen-to-ovule ratio Flower visitors Floral morphology and seed weight Discussion Conclusions Methods Data availability References Acknowledgements Author information Ethics declarations Additional information Supplementary Information Rights and permissions About this article Comment