Procjena analgezije opioidima i neopioidima intermitentnom primjenom i samostalna kontrola pumpom nakon lumbalne diskektomije [Opioid and nonopioid analgesia assessment through intermittent application and patient controlled analgesia pump after lumbar discectomy]

Low back pain is one of the leading cause of disabilty in an adult, working-active population representing a serious socioeconomic problem. Lumbar discectomy is the gold standard in symptomatic herniated disk treatment. Despite the advances in medicine, pharmacology and technology, postoperative pain frequency is still high. Hypothesis of this disertation is that opioid analgesia delivered by patient controlled pump is more effective in pain reduction compared to opioid intermittent analgesia and nonopioid analgesia after lumbar discectomy. The objectives were to determine the efficacy of two analgesics applied in different ways comparing the most effective method of analgesia. The study included 200 patients treated at the Department of Neurosurgery Sestre milosrdnice Clinical Hospital Center, during 14 months period. The scientific contribution of prospective, randomized clinical study is statistically significant difference of achieving analgesia after lumbar discectomy by patient controlled pump versus intermittent analgesia. No statistically significant differences were found by comparing types of used drugs. Based on the results obtained, it can be concluded that analgesia delivered by patient controlled pump will significantly contribute to postoperative pain reduction. Therefore it could be recommended introducing patient controlled pump as a standard in order to achieve more effective analgesia regardless of applied analgesic

Ethical aspects in community nursing in Croatia

The philosophy of public health nursing is based on the belief that care directed towards the individual, his family and different social groups, contributes to the protection of overall population health. Nurses’ care for health is not limited only to age or different disease groups, but it refers to all other activities which contribute to health improvement – prevention, rehabilitation, concern for social justice, reducing disparities in providing health care services, and advocating the interests of community members. It is an unavoidable fact that every health situation includes a set of value judgements or norms, therefore every decision that is made has in itself a moral component as well. There is a small number of research dealing with examining the capacity for cognition of moral dilemmas, moral deliberation, decision-making and implementing those decisions in nursing practice, especially in public health nursing. Since almost one third of the nurses (about ten thousand) in the Croatian health system work in community health care the aim of the authors was to determine how well the nurses were informed about the formal bodies that deal with ethical questions in their institutions (ethical committees) and wider community, and the number of nurses who are members of these committees; whether they know who to refer to for help in identifying and solving their ethical problem (formal bodies, health and other institutions) and how they perceive their capability in identifying and solving an ethical problem. Another aim was to determine which moral dilemmas nurses encounter in their everyday practice. The results of the research would be used for the advancement of nursing practice in public health nursing in the Republic of Croatia. The sample consisted of 300 nurses, out of which 200 finished secondary level of education, 100 finished undergraduate and graduate study programme. A questionnaire on how well the nurses are informed and how they perceive their knowledge and skills in the field of nursing ethics. The questionnaire consisted of 16 questions and one open-ended question where nurses could write about most often encountered moral dilemmas in their practice. The results of the research have shown that nurses who work in community are not sufficiently informed about the existence and formal structure of the bodies that deal with ethical questions in their institutions and wider community, and that they do not perceive their knowledge and skills as being sufficient for dealing with moral dilemmas in practical situations. Furthermore, it can be noted that, during stating ethical dilemmas they encounter in everyday practice, they are a lot more oriented towards themselves, mutual relations in the team and moral dilemmas which come within the competence of a doctor, while not mentioning the issues of social justice, disparity in providing health services, as well as issues of being informed, dignity and mistanasia of community members. The reasons for that are to be found in a deficient theoretical education in the field of their professional ethics, especially when considering nurses with a secondary level education. Even though the nurses with higher education demonstrate more theoretical knowledge and understanding, they have not demonstrated sufficient confidence in three questions that are essential for practical application of knowledge and skills

Brzo antigensko testiranje studenata i djelatnika Zdravstvenog veleučilišta na SARS-CoV-2: prikaz iskustva ustanove

Prevencija pojavnosti bolesti COVID-19 unutar visokoobrazovnog okruženja predstavlja jedinstvene izazove. Testiranje studentske populacije zahtijeva i velik broj testova. Obzirom na potrebe korištenja laboratorijskih kapaciteta u slučaju provedbe PCR testiranja, racionalno rješenje za provedbu masovnih testiranja jesu brzi antigenski testovi. Brza identifikacija SARS- CoV-2 polazišna je točka u upravljanju pandemijom COVID-19, a za realizaciju istog su na tržištu dostupni brzi antigenski testovi (BAT). BAT je pouzdan, brz kromatografski imunološki test za kvalitativno otkrivanje specifičnih antigena SARS-CoV-2 prisutnih u nazofarinksu. Testiranje se izvodi uzimanjem obriska sluznice nazofarinksa, a rezultati su vidljivi već nakon desetak minuta od testiranja. Od mjeseca listopada 2021. do mjeseca ožujka 2022. ukupno je provedeno 1545 brzih antigenskih testiranja studenata Zdravstvenog veleučilišta. U ukupnom broju testiranih (N=1545) bilo je 12 pozitivnih rezultata što predstavlja udio u ukupnom broju od 0,8%. U navedenom nom razdoblju provedeno je i 121 brzo antigensko testiranje djelatnika. U ukupnom broju testiranja djelatnika (N=121) bila su 2 pozitivna rezultata što predstavlja udio od 1,7%. Čimbenici koji su pridonijeli našem programu brzog antigenskog testiranja uključuju jednostavnost pristupa i praktičnost elektroničke prijave na testiranje, proaktivnu komunikacijsku strategiju, angažman studentskih predstavnika i prodekana, jutarnje termine testiranja, iskusne nastavnike zdravstvene djelatnike koji su provodili testiranje, osiguranu dovoljnu količinu potrošnog materijala te brzinu provedbe i dostupnost elektroničke potvrde o provedenom testiranju s posebnom pozornošću na upravljanje osobnim podacima

Važnost oralne higijene u smanjenju incidencije ventilatorom uzrokovane pneumonije – sustavni pregled literature

Introduction. Healthcare-associated infections (HCAIs) represent a major public health problem. Inadequate oral hygiene in intensive care units has been recognized as a critical issue for the occurrence of one of these infections – ventilator-associated pneumonia (VAP). Although literature suggests diverse oral care measures for ICU patients, the effectiveness of each is still a subject for further trials. Aim. The purpose of this paper is to determine the association between diverse oral care measures and the incidence of ventilator associated pneumonia. Methods. A systematic review of literature in the PubMed database that evaluates the performance of diverse oral care measures and their impact in reducing the incidence of VAP. The keywords used as search terms were: oral hygiene, ventilator-associated pneumonia, intensive care unit and nursing. Results. Four articles in total were taken into consideration in accordance with the availability of full-text articles and years of publication between 2009 and 2019. Performance results of diverse oral care measures haven’t shown statistically significant differences, but the implementation of oral care as a preventive measure against VAP showed a significant role in lower incidence rates. Conclusion. The results of the systematic literature review confirmed the importance of oral care in lowering the incidence rate of VAP. However, significant differences have been noted between the efficiency of diverse oral care measures and the incidence rate of VAP.Uvod. Infekcije povezane s bolničkom skrbi predstavljaju veliki javnozdravstveni problem. Neadekvatna oralna higijena u jedinicama intenzivnog liječenja jedan je od rizičnih čimbenika za nastanak jedne od takvih infekcija – ventilatorom uzrokovane pneumonije. Postoje različite tehnike provođenja higijene, no efikasnost svake od njih još je uvijek područje istraživanja. Cilj. Utvrditi povezanost metoda higijene usne šupljine i pojave ventilatorom uzrokovane pneumonije. Metode. Sustavni pregled literature u bazi podataka PubMed u cilju pronalaženja članaka koji evaluiraju povođenje higijene usne šupljine i njihov utjecaj na incidenciju VAP-a. Ključne riječi upotrijebljene u pretraživanju baze: oralna higijena, ventilatorom uzrokovana pneumonija, jedinica intenzivnog liječenja, sestrinstvo. Rezultati. U obradu su uzeta četiri članka prema kriterijima dostupnosti cjelovitog teksta i godinama publikacije između 2009. i 2019. Rezultati nisu pokazali statistički vidljive razlike u incidenciji VAP-a na temelju različitih metoda održavanja oralne higijene, no implementacijom oralne higijene kao sastavne preventivne mjere VAP-a vidljiv je znatan utjecaj na smanjenje incidencije. Zaključak. Rezultati sustavnog pregleda literature potvrdili su važnost provođenja higijene usne šupljine u svrhu smanjenja incidencije VAP-a. Međutim, vidljive su razlike u efikasnosti metoda provođenja higijene u pogledu njihova utjecaja na smanjenje stope VAP-a

Evaluacija ishoda sestrinske skrbi bolesnika nakon postupka trombolize – retrospektivna studija

Introduction. Nursing documentation is an indicator of healthcare quality. After extensive data analysis, it has been shown that nursing documentation has become an assessment tool and a tool to change clinical practice. Stroke is the most significant individual cause of disability in the adult population. In instances of ischemic stroke, brain circulation is abruptly disconnected. Causes of this break in blood flow may be blockage or compression of blood vessels due to thrombosis, embolism or systemic hypoperfusion. Therapy administered in cases of acute ischemic stroke includes intravenous thrombolytic therapy – recombined tissue activator of plasminogen within 180, i.e. 270 minutes of the stroke. Aim. To determine the quality of outcomes as regards patient care after administering thrombolytic therapy in a display of progress notes of patients’ condition during their stay in the hospital, both before and after administering thrombolytic therapy. Methods. A retrospective study was carried out at the neurology department of „Dr. Ivo Pedišić“ General Hospital in Sisak during 43 months from January 1, 2013 to May 31, 2017. 85 patients participated in the study. Data were obtained from one component of nursing documentation in electronic form, namely progress notes on the patients’ conditions. Results. With a 95% confidence level, a statistically significant difference (p<0.05) was found for parameters of hygiene, feeding, elimination, dressing, walking, moving, sitting, standing, turning, nutrition - diet, strain tolerance, Braden scale and categorization, before and after thrombolytic therapy. Statistical significance was not found in the parameters of pain (p=0.067), GCS/Trauma score scale (p=0.339), risk of fall (p=0.072). Conclusion. The implementation of the healthcare process, continued monitoring of the patient’s condition and progress, as well as validation of nursing activities provide an imperative for the application of nursing documentation as an essential tool in describing regular nursing activities. Application of documentation enables a more permanent insight into a patient’s general state, data availability, care continuity, progress chronology and result evaluation, as well as a material background for professional, expert and scientific development of nurses through studies in the field of nursing.Uvod. Sestrinska dokumentacija pokazatelj je kvalitete zdravstvene njege. Analizom podataka, sestrinska dokumentacija postaje alat u procjeni i promjeni kliničke prakse. Moždani udar najveći je pojedinačni uzrok invaliditeta kod odrasle populacije. Kod ishemijskoga moždanog udara dolazi do naglog prekida moždane cirkulacije. Uzroci prekida cirkulacije mogu biti začepljenje ili suženje krvne žile uzrokovane trombozom, embolijom ili sustavnom hipoperfuzijom. U praksi se primjenjuje terapija za akutni ishemijski moždani udar koja uključuje intravensku primjenu trombolitičke terapije – rekombiniranoga tkivnog aktivatora plazminogena unutar prvih 180 odnosno 270 minuta od nastanka moždanog udara. Cilj. Utvrditi ishode skrbi bolesnika nakon primjene trombolitičke terapije prikazom sažetka praćenja stanja bolesnika tijekom hospitalizacije, a u vremenu prije i nakon primijenjene trombolize. Metode. Retrospektivna studija provedena je na odjelu neurologije u Općoj bolnici „Dr. Ivo Pedišić” u Sisku kroz 43 mjeseca u periodu od 1. siječnja 2013. do 31. svibnja 2017. U provedenoj studiji sudjelovalo je 85 ispitanika. Podaci su prikupljeni na temelju sastavnice sestrinske dokumentacije u elektroničkom obliku: sažetka praćenja stanja bolesnika. Rezultati. S razinom pouzdanosti od 95 % utvrđena je statistički značajna razlika (p < 0,05) kod parametara higijene, hranjenja, eliminacije, oblačenja, hodanja, premještanja, sjedanja, stajanja, okretanja, prehrane – dijete, podnošenja napora, Bradenove skale i kategorizacije, a prije i poslije trombolize. Statistička značajnost nije utvrđena kod parametara bol (p = 0,067), GCS / Trauma score ljestvice (p = 0,339) i rizik za pad (p = 0,072). Zaključak. Primjena procesa zdravstvene njege, kontinuirano praćenje stanja bolesnika, ali i vrednovanje sestrinskog rada daje imperativ primjeni sestrinske dokumentacije kao važnom alatu za opis sestrinske prakse. Primjena dokumentacije omogućuje trajni uvid u stanje bolesnika, dostupnost podataka, kontinuitet skrbi, kronološki pregled i evaluaciju rezultata, kao i materijalnu podlogu za profesionalni, stručni i znanstveni razvoj medicinskih sestara kroz istraživanja u sestrinstvu

Psihološki aspekti lumbalnog bolnog sindroma

Lumbalni bolni sindrom [LBS] zdravstveni je i socioekonomski problem koji se očituje čestim traženjem liječničke pomoći, visokom cijenom usluga zdravstvene skrbi, čestim izostancima s aktivnih radnih zadataka, visokim učestalošću radne nesposobnosti i visokom incidencijom invaliditeta. Čest naziv za sindrom danas je „bolest civilizacije“. Posebice kronična bol znatno smanjuje kvalitetu života bolesnika i njegove obitelji. Prevalencija kronične boli u pučanstvu RH iznosi od 15 do 22%, a više od 80% pučanstva tijekom života oboli od lumbalnog ili cervikalnog bolnog sindroma. Mnogo se češće javlja u žena, i to u starijoj životnoj dobi, kao i u osoba slabijeg socioekonomskog statusa. Bol, posebice kronična, ima i psihološku simptomatologiju. Psihosomatska medicina proučava povezanost psihičkih poremećaja sa somat- skim poremećajima [utjecaj psihosocijalnog stresa na nastanak boli]. Kod osoba s razvijenim kroničnim bolnim sindromom stvara se tzv. „začarani krug“: [bol dovodi do neaktivnosti, neaktivnost do slabosti, a slabost do pojačanja bolnosti]. Mogućnost podnošenja boli ovisna je o značajkama osobnosti, raspoloženju, okolnostima, dobi. Iskustva stečena tijekom životnog vijeka, razumijevanje mehanizma boli i kulturalna obilježja izravno utječu na subjektivni doživljaj boli. Učinkovito tretiranje boli počinje metodama za znanstvenu procjenu i evaluaciju postupaka/metoda za umanjenje boli. U odnosu na ostale članove zdravstvenog time, medicinska sestra provodi najviše vremena u izravnom kontaktu s bolesnikom, Zato medicinska sestra mora poznavati metode/postupke koji znatno umanjuju bol. Najuvrježenija meto- da/postupak u svakodnevnoj uporabi u radu medicinske sestre edukacija je bolesnika i članova njegove obitelji. Uporabom znanstveno verificiranih metoda/postupaka zdravstvene njege za umanjenje boli, medicinska sestra omogućuje da bolesnik očuva ljudsko dostojanstvo te istodobno poveća povjerenje u sve članove zdravstvenog tima, i to neovisno o težini bolesti i krajnjem ishodu liječenja

Ishodi izvanbolničkog srčanog zastoja - poboljšanje uspješnosti kardiopulmonalne reanimacije od strane laika

Approximately 8000 people suffer from an out-of-hospital cardiac arrest (OHCA) in the Republic of Croatia every year. OHCA survival rates generally remain low despite major advances in resuscitation. Its incidence and survival rate are well known in many European countries, but reliable data on OHCA in Croatia are lacking. The aim of the study was to determine survival rate of patients with OHCA in the Republic of Croatia and the importance of the community bystander cardiopulmonary resuscitation (CPR) rates in the survival chain. This prospective observational study performed between October 1, 2017 and December 31, 2017 included all adult patients with OHCA in Croatia who were treated by Emergency Medical Services (EMS). OHCA data were collected from the Croatian Institute of Emergency Medicine database and Utstein cardiac arrest data collection form. Descriptive data presentation was used in the analyses. Data were expressed as absolute frequencies and percentages and central tendency measures. Testing of correlations in return of spontaneous circulation (ROSC) was performed by logistic regression. During the observation period, a total of 1763 adult patients without signs of circulation were assessed by EMS in Croatia and 760 (43%) adult patients were resuscitated by EMS personnel. Outcomes measured in ROSC until emergency department admission were reported in 126 (17%) cases. Shockable rhythm vs. non-shockable rhythm (OR: 5.832, 95% CI: 3.621-9.392; p<0.001) and bystander witnessed cardiac arrest (OR: 8.213, 95% CI: 2.554-26.411, p<0.001) were significantly associated with a higher probability of survival. There was no significant difference in correlation with day or night shift, etiology of cardiac arrest and bystander CPR variables. Survival rate of OHCA patients who received CPR until emergency department admission in Croatia was 17%. A higher survival rate post-OHCA was more likely among patients who received bystander CPR and had shockable rhythm.U Republici Hrvatskoj izvanbolnički srčani zastoj (ISZ) doživi oko 8000 osoba na godinu. Preživljenje od ISZ općenito ostaje nisko unatoč velikom napretku u reanimaciji. Njegova incidencija i stopa preživljenja dobro su poznati u mnogim europskim zemljama, ali pouzdani podaci o ISZ u Hrvatskoj nedostaju. Cilj istraživanja bio je utvrditi stopu preživljenja bolesnika s ISZ u Republici Hrvatskoj i važnost kardiopulmonalne reanimacije (KPR) provedenu od strane laika u cjelokupnom lancu preživljenja. Ova prospektivna opservacijska studija provedena od 1. listopada 2017. do 31. prosinca 2017. obuhvatila je sve odrasle bolesnike s ISZ u Hrvatskoj koji su bili zbrinjavani od djelatnika hitne medicinske službe (HMS). Podaci o ISZ prikupljeni su iz baze podataka Hrvatskoga zavoda za hitnu medicinu i obrasca za prikupljanje podataka o srčanom arestu Utstein. U analizama je primijenjen deskriptivni prikaz podataka. Podaci su izraženi kao apsolutne frekvencije i postoci te mjere središnje tendencije. Testiranje korelacija povratka spontane cirkulacije (return of spontaneous circulation, ROSC) provedeno je logističkom regresijom. Tijekom razdoblja promatranja ukupno su u izvanbolničkoj HMS na području Republike Hrvatske bile 1763 odrasle osobe bez znakova cirkulacije, a 760 (43%) odraslih bolesnika reanimirano je od strane osoblja HMS. Ishodi mjereni po povratku spontane cirkulacije (ROSC) do prijma u hitnu bolničku službu prijavljeni su u 126 (17%) slučajeva. Ritam koji je za defibrilaciju u odnosu na ritmove srčanog zastoja koji se ne defibriliraju (OR: 5,832, 95% CI: 3,621-9,392; p<0,001) i osvjedočeni srčani zastoj od strane laika (OR: 8,213, 95% CI: 2,554-26,411, p<0,001) bili su značajno povezani s većom vjerojatnošću preživljavanja. Nije bilo značajne razlike u korelaciji s dnevnom ili noćnom smjenom i etiologijom srčanog zastoja. Stopa preživljenja bolesnika s ISZ u Republici Hrvatskoj kod kojih je provedena kardiopulmonalna reanimacija do prijma u hitnu bolničku službu bila je 17%. Veća stopa preživljenja nakon ISZ bila je vjerojatnija među bolesnicima kod kojih je započeta kardiopulmonalna reanimacija od strane laika i koji su imali srčani ritam za defibrilaciju

The role of immunophenotyping in differential diagnosis of chronic lymphocytic leukemia

Introduction. Accurate diagnosis of chronic lymphocytic leukemia (CLL) acquires immunophenotyping by flow cytometry in order to facilitate differential diagnosis between CLL and other mature B-cell neoplasms (MBCN). Objective. The aim of this study was to define immunological profile of CLL cells. Methods. Immunophenotyping by flow cytometry was performed on peripheral blood specimens at diagnosis in the group of 211 patients with de novo MBCN. Results. Absolute count of B-cells was significantly increased in all MBCN patients comparing to healthy control group (p<0.05). B-cell monoclonality was detected in 96% of all MBCN patients, by using surface immunoglobulin (sIg) light chain restriction. B-cell antigens, CD19, CD20, CD22, were expressed with very high frequency in CLL and other MBCN. In comparison with other MBCN, in CLL group, the frequency of expression was higher for CD5 and CD23 (p<0.0001), though lower for FMC7 antigen (p<0.0001). CLL patients were characterized by lower expression patterns of CD20, CD22, CD79b, and sIg (p<0.0001) as well as higher expression pattern of CD5 antigen (p<0.05). Correlation between the final diagnosis of MBCN and values of CLL scoring system showed that the majority of CLL patients (97%) had higher values (5 or 4) whereas the majority of other MBCN patients (96%) had lower score values (0-3). Conclusion. Our results have shown that characteristic immunophenotype which differentiates CLL from other MBCN is defined by following marker combination - CD19+ CD20+low CD22+low CD5+high CD23+ FMC7- CD79b+low sIg+low. CLL score values of 5 or 4 points are highly suggestive for diagnosis of CLL

Mišljenje učenika završne godine srednje medicinske škole i studenata završne godine preddiplomskog studija sestrinstva o doniranju organa

Aim. To examine and compare the opinions of the final year secondary health care students and the final year students of the undergraduate Nursing study programme about the significance of organ donation. Methods. A cross-sectional study was conducted on a sample of 60 participants of whom 30 were undergraduate Nursing study programme students and 30 were secondary health care students. The research instrument was a questionnaire designed for the purpose of this study, which included the following groups of questions: the first group consisted of questions about the participants’ general data, while the second group contained questions about organ donation itself. Results. From the obtained results, it was determined that there is no statistically significant difference in the decision to donate organs depending on the level of education. Furthermore, the results show that both groups of participants want to donate organs and the main motivation is to rescue someone’s life. In addition, the majority of participants express the view that such behavior is a humane act. Conclusion. Education level does not affect organ donation decision making. The main motivation for deciding on donating organs is to rescue someone’s life. Organ donation is an act of humanity. In the survey, several respondents expressed negative opinion about organ donation. Therefore, it is recommended that workshops aimed at future health professionals, be organized in secondary health care schools and other educational institutions for healthcare professionals to emphasize the importance of organ donation.Cilj. Ispitati i usporediti mišljenja učenika završne godine srednje medicinske škole i studenata završne godine preddiplomskog studija sestrinstva o važnosti doniranja organa. Metode. Provedena je presječna studija na ukupno 60 ispitanika od kojih je 30 učenika srednje medicinske škole i 30 studenata preddiplomskog studija sestrinstva. U prikupljanju podataka primijenjen je upitnik izrađen za potrebe ovog istraživanja koji je sadržavao sljedeće skupine pitanja: u prvoj skupini pitanja o općim podacima ispitanika, a u drugoj skupini pitanja o tematici doniranja organa. Rezultati. Dobivenim rezultatima utvrđeno je da ne postoji statistički značajna razlika kod donošenja odluke o doniranju organa ovisno o stupnju obrazovanja. Nadalje, rezultati su pokazali da i učenici završne godine srednje medicinske škole i studenti završne godine preddiplomskog studija sestrinstva žele donirati organe te im je glavna motivacija spašavanje nečijeg života, a dodatno većina ispitanika izražava stav da je takvo postupanje human čin. Zaključak. Stupanj obrazovanja ne utječe na donošenje odluke o doniranju organa. Glavna je motivacija prilikom donošenja odluke o doniranju organa spašavanje nečijeg života. Doniranje organa je human čin. U istraživanju je nekoliko ispitanika izrazilo negativno mišljenje o doniranju organa. Stoga je preporuka da se u srednjim medicinskim školama i ostalim obrazovnim ustanovama za zdravstvene djelatnike organiziraju radionice koje imaju cilj budućim zdravstvenim djelatnicima ukazati na važnost doniranja organa