Sindrom izgaranja kod anesteziologa u radu s COVID bolesnicima na mehaničkoj ventilaciji u Kliničkom bolničkom 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 među anesteziolozima koji su radili u covid jedinici intenzivnog liječenja (respiracijski centar), usporediti razliku pojavnosti sindroma izgaranja između njih i liječnika koji u vrijeme pandemije nisu radili u covid jedinici intenzivnog liječenja, te ispitati postoji li razlika pojavnosti sindroma izgaranja među anesteziolozima s obzirom na spol, dob i specijalističko usavršavanje. U tu svrhu provedena je presječna studija. Istraživanje je provedeno na 60 liječnika od kojih je 30 liječnika koji su u vrijeme pandemije bolesti COVID-19 radili u respiracijskom centru te 30 liječnika koji u istom razdoblju nisu radili u respiracijskom centru. Rezultati su prezentirani uz pomoć upitnika čiji zbroj ispitanike svrstava u skupinu bez izgaranja, početnog izgaranja ili visokog stupnja izgaranja. Na temelju istraživanja utvrđeno je da se 53% liječnika prezentira sindromom izgaranja, a većinu među njima čine anesteziolozi. Među njima je 37% anesteziologa koji imaju početno izgaranje i 20% njih koji pripadaju skupini visokog izgaranja. U žena je sindrom prepoznat među 58% ispitanica. U skupini starijih od 35 godina prisutno je 59% slučajeva sindroma izgaranja, dok je ta brojka među specijalistima 75%. U ukupnom uzorku utvrđen je veći udio sindroma izgaranja nego što su to pokazala prethodna istraživanja. Među njima prevladavaju liječnici Klinike za anesteziologiju koju su u vrijeme pandemije radili s teško bolesnim COVID pacijentima. U skupini ispitanih anesteziologa simptomi su bili češći među ženama, među liječnicima starijim od 35 godina te među specijalistima

Epidemiologija prijeloma kosti u odrasloj dobi prema uzroku ozljede, lokaciji prijeloma i vrsti liječenja u istočnoj 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 ‘fall in level’ 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 liječeni na traumatološkom odjelu najveće bolnice u istočnoj Hrvatskoj, stacionarno ili ambulantno. Ukupan broj bolesnika bio je 15.519 sa 17.257 prijeloma. Prema načinu liječenja 71% bolesnika liječeno je ambulantno, a 29% stacionarno; 11.046 ambulantnih bolesnika su liječeni zbog 12.187 prijeloma, dok su 4473 stacionarna bolesnika liječeni zbog 5070 prijeloma. Skupina bolesnika muškog 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. Muškarci stariji od 65 godina su imali 9717 prijeloma ili 27% od ukupnih prijeloma. “Pad u razini” bio je najčešći uzrok ozljeđivanja. Osteoporotski prijelomi bili su češći u skupini žena starijih od 65 godina nego kod muškaraca 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 “shrinkage effect” 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.Najčešći uzrok lumbalne radikularne boli su patološke promjene intervertebralnog diska. Lumbalna diskus hernija (LDH) je najčešći uzrok lumbosakralnog radikularnog sindroma i pogađa 1-2% opće populacije, stavljajući značajan teret na zdravstvene usluge i gospodarstvo u cijelom svijetu. Prekomjerna količina ožiljnog tkiva nakon lumbalne mikrodiscektomije može povećati postoperativnu bol. Postoperativna fibroza je jedan od najvažnijih uzroka sindroma neuspjele operacije leđa 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 hidrauličkom prostoru (nucleus pulposus) dovodi do smanjenja intradiskalnog tlaka i implicira termički „učinak skupljanja“ sa povlačenjem hernije diska i dekompresiju živčanog korijena što ima za posljedicu smanjenja lumbalne radikularne boli. Dosadašnja istraživanja pokazala su učinkovito smanjenje boli poslije PLDD, te mali broj komplikacija samog zahvata. PLDD je siguran i djelotvoran zahvat kod dobro probranih bolesnika. Nažalost, ne postoje još velike, randomizirane prospektivne studije iz PLDD kod lumbalne radikularne boli, te su navedena istraživanja potrebna u budućnosti kako bi potvrdila ili osporila dosadašnje rezultate

Razlike u mjerenjima brzine otkucaja srca te broja učinjenih koraka usporedo mjerenih skupim i jeftinim pametnim satom

Cilj ovoga istraživanja bio je ispitati razliku između mjerenja brzine otkucaja srca te broja učinjenih koraka, mjerenih istovremeno skupim i jeftinim pametnim satom, uz statističku obradu prikupljenih podataka Passing Bablok regresijskom analizom. Statistička metoda Passing Bablok regresijske analize služi za usporedbu mjerenja iste varijable s dva različita mjerna instrumenta, a svrha istraživanja bila je ispitati koliko se korisnici pametnih satova mogu osloniti na rezultate mjerenja dobivene ovim uređajima. Mjerenja su izvršena na jednome ispitaniku, autoru ovoga istraživanja, s po jednim satom na svakoj ruci uz povremenu izmjenu ruku. Ovim istraživanjem potvrđeno je da postoji razlika u mjerenjima između dva pametna sata, kako međusobno tako i s obzirom na samostalno mjerenje koraka i otkucaja srca. Međutim, potrebna su daljnja istraživanja koja bi pokazala koji je sat točniji te koliko odstupa od stvarnih vrijednosti uvođenjem drugih modela satova te referentnih mjernih uređaja. Zaključno, pametni sat može se koristiti u privatne svrhe radi okvirnoga praćenja fizikalnih veličina, no ostaje upitna njegova točnost 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 – 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 – 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 nurses’ turnover intention. (Smokrović E, Gusar I, Hnatešen D, Bačkov K, Bajan A, Grozdanović 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 patient’s 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 liječenja povećana je stopa preživljena naročito ako se bolest otkrije u ranom stadiju. Jedan od imperativa je kvaliteta života bolesnice nakon liječenja. Neadekvatno liječena akutna poslijeoperacijska bol dovodi do lošijeg ishoda liječenja i razvoja kronične boli. Incidencija kronične boli nakon operativnog liječenja karcinoma dojke je visoka i dugoročno negativno utječe na kvalitetu života bolesnica. Serratus anterior plane block (SAPB) je relativno nova ultrazvukom vođena 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 kratkoročnu i dugoročnu 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 kronične boli i na taj način poboljšava se kvaliteta života

Utjecaj različitih minimalno invazivnih metoda na ishod liječenja 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, društveni i ekonomski problem i često je uzrok profesionalne nesposobnosti. Cilj ovog istraživanja bio je usporediti intenzitet boli, onesposobljenost i neuropatsku bol ovisno o načinu liječenja (epiduralna injekcija steroida ili perkutana laserska dekompresija diska) u liječenju lumbalne radikularne boli uzrokovane hernijom intervertebralnog diska sa ili bez diskoradikularnog kontakta. Podaci su prikupljeni od 28 pacijenata u 3 točke mjerenja (prije zahvata i na pregledima 15. i 30. dana nakon zahvata) pomoću Numeric Rating Scale (NRS), Oswestry Disabilitiy Indeks (ODI) i Pain Detect. Smanjenje boli nakon zahvata bilo je statistički značajno samo u skupini bolesnika s diskoradikularnim kontaktom kod kojih je učinjen PLDD (p = 0,04). Iz dobivenih rezultata može se zaključiti da je PLDD doveo do većeg smanjenja onesposobljenosti (p = 0,009 ) u bolesnika s diskoradikularnim kontaktom a ESI u bolesnika bez diskoradikularnog kontakta (p = 0,02 ). Rezultati pokazuju da je došlo do značajnog (p = 0,01) smanjenja neuropatske boli u bolesnika bez diskoradikularnog kontakta koji su liječeni ESI i u bolesnika s diskoradikularnim kontaktom koji su liječeni 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 ‘fall in level’ 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 radiološka dijagnostika akutnih ozljeda trokutastog vezivno-hrskavičnog 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-hrskavičnog kompleksa (triangular fibrocartilage complex, TFCC) pomoću 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 muškaraca u dobi od 22-61 godine, srednja dob 37 godina; 50 desnih ručnih zglobova i 22 lijeva ručna zgloba) s kliničkom sumnjom na ozljedu TFCC pomoću standardnih radiograma i UZV. Naposljetku smo potvrdili ozljedu TFCC pomoću 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. Zaključeno je kako je UZV vrijedna metoda za prikaz intraartikularnog izljeva, mekih česti, površine kosti, kao i za ranu dijagnostiku prijeloma koji nisu bili vidljivi standardnim rtg snimkama. MR je bolja dijagnostička metoda za prikaz struktura, ali za pouzdan i točan prikaz TFCC i pripadajućih patoloških 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