Sfidat e menaxhimimit me infermierë në Qendrën Klinike Universitare të Kosovës

Pozita e menaxherit me infermierë është komplekse dhe nënkupton shkathtësi interaksioni me pacientë dhe familjarë, infermierë, mjekë, punëtorë të tjerë shëndetësor në shëndetësi si dhe me drejtuesit e institucionit. Ky punim analizon sfidat me të cilat ballafaqohet menaxheri me inferimerë në Qendrën Klinike Universitare të Kosovës gjatë ushtrimit të kësaj detyre. Autorët kanë intervistuar 30 menaxherë të lartë në infermieri. Përgjigjet e fituara janë përpunuar në mënyrë statistikore. Studimi ka gjetur se edhe pse menaxheri me infermierë është pjesëmarrës në përpilim të planeve të mjekimit në shumicën e rasteve, ai në asnjë rast nuk ka marrë pjesë në përpilimin e protokoleve të mjekimit. Pjesa më e madhe e menaxherëve kanë pohuar se ka interferim të plotë ose të pjesshëm të menaxhmentit ose të mjekëve në kompetencat e tyre. Shpërblimi me ditë të lira dhe ndërrimi i vendit të punës janë instrumente të vetme të menaxherëve për të motivuar dhe sanksionuar të subordinuarit. Gati gjysma e menaxherëve nuk dinë si janë të vlerësuar nga eprorët, ndërsa çdo i katërti nuk pajtohet me vlerësimin. Shumica janë të kënaqur me imazhin publik të infermierit. Sfidat e menaxhimit me infermierë kërkojnë redefinimin e rolit të menaxherit dhe forcimin e pozicioni të tij

The challenges of nurse management at the University Clinical Center of Kosova

The role of the nurse manager is complex and requires advanced skills when communicating with patients and their families, nurses, doctors, other health and allied workers as well as superiors. This paper analyzes the challenges of nurse management at the University Clinical Center of Kosovo. The authors interviewed 30 senior nurse managers. Although in a large percentage (90%) are a part of a planning for the future in respective clinics, nurse managers were never involved in writing treatment protocols. The majority of the managers reported absolute or partial intrusion of the hospital management and doctors in performing their daily duties. Paid leave as an award and change of the assignment as a penalty, are the only instruments in the hand of nurse managers to motivate or sanction nurses. Almost half of the managers do not know how their performance is evaluated by the superiors, while every fourth of the nurse managers do not agree with the evaluation. Majority is satisfied with the public image of the profession. The difficulties that nurse managers are facing are mainly linked to the poor definition of their position and roles, but also at the poor exercise of the delegated competencies

Bullet embolization to the external iliac artery after gunshot injury to the abdominal aorta: a case report

Abstract Introduction Abdominal vascular trauma is fairly common in modern civilian life and is a highly lethal injury. However, if the projectile is small enough, if its energy is diminished when passing through the tissue and if the arterial system is elastic enough, the entry wound into the artery may close without exsanguination and therefore may not be fatal. A projectile captured may even travel downstream until it is arrested by the smaller distal vasculature. The occurrence of this phenomenon is rare and was first described by Trimble in 1968. Case presentation Here we present a case of a 29-year-old Albanian man who, due to a gunshot injury to the back, suffered fracture of his twelfth thoracic and first lumbar vertebra, injury to the posterior wall of his abdominal aorta and then bullet embolism to his left external iliac artery. It is interesting that the signs of distal ischemia developed several hours after the exploratory surgery, raising the possibility that the bullet migrated in the interim or that there was a failure to recognize it during the exploratory surgery. Conclusion In all cases where there is a gunshot injury to the abdomen or chest without an exit wound and with no projectile in the area, there should be a high index of suspicion for possible bullet embolism, particularly in the presence of the distal ischemia.</p

A decade of civilian vascular trauma in Kosovo

<p>Abstract</p> <p>Purpose</p> <p>We sought to analyze the results of arterial injury management in a busy metropolitan vascular unit and risk factors associated with mortality and morbidity.</p> <p>Patients and methods</p> <p>We analyzed 120 patient with arterial injury treated between year 2000 and 2010 at the University Clinical Center of Kosovo. Seven of these years were prospective and three retrospective study.</p> <p>Results</p> <p>The mechanism of arterial injury was stabbing 46.66%, gunshot wounds in 31.66%, blunt in 13.33%, and landmine in 8.33%. The most frequently injured vessel was the superficial femoral artery (25%), followed by the brachial artery (20.9%), crural arteries (13.1%), forearm arteries (14.3%), iliac arteries (7.5%), abdominal aorta (3.3%), common femoral artery (3.3%) and popliteal artery (3.3%). Associated injuries including bone, nerve and remote injury (affecting the head, chest, or abdomen) were present in 24.2% of patients. The decision to operate was made based on the presence of “hard signs” of vascular trauma. Arterial reconstruction was performed in 90.8% of patients, 5.8% of patients underwent primary amputation and 3.2% died on the operation table. Overall survival rate was 95.8%.</p> <p>Conclusion</p> <p>Injuries to the arteries are associated with significant mortality and morbidity. Mechanism of injury (blunt, gunshot, landmine or stub), hemodynamic stability at the admission, localization of injury, time from injury to flow restitution, associated injuries to the structures in the region and remote organs are critical factors influencing outcome.</p

Clinical Dilemmas and Surgical Treatment of Penoscrotal, Scrotal and Perineal Hypospadias

Hypospadia is the most common congenital malformation of the urinary tract. It is a malformation with the opening of the urethra proximally from the usual site. The meatal opening can be anywhere alone the shaft of the penis, or in more severe forms, within the scrotum, or in the perineum. Consequently the hypospadias can be distal, medial and proximal. The proximal ones can be penoscrotal (PS), scrotal (SC) and perineal (PE). The cause of hypospadias is largely unknown; however, current epidemiol-ogy and laboratory studies have shed new light into the etiology of hypospadias. With recent advance-ments in molecular biology, microarray technology, it appears that hypospadias is potentially related to disrupted gene expression. Currently, the only available treatment is surgery. The aim of this study was to present our results of the surgical correction of hypospadias and methods used to answer the clinical dilemmas about the gender. Authors have used two methods for a surgical resolution of the hypospadia - one-step operation suggested by Snodgrass and two-step operation, employing free graft suggested by Bracka. Clinical dilemmas regarding the gender were answered using cytogenetic assessment through lymphocyte cultivation method, suggested by Seabright. The cytogenetic assessment was carried in 23 patients with proximal hypospadia (penoscrotal, scrotal and perineal). Characteristic male cariotype (46, XY) was found in 22 patients. In one patient, with scrotal hypospadia, we found the characteristic female cariotype. This patient had testicles. The patient with female cariotype had a TDG gene that determines the differentiation of the testicles. Although surgery remains the only therapy for the treatment of the hypospadias, better understanding of the molecular and hormonal mechanisms behind the diseases may contribute to the prevention and the decrease in the incidence of the malformation. Cytogenetic testing in patients with unclear gender is important in planning further treatment

Gallbladder ascariasis in Kosovo – focus on ultrasound and conservative therapy: a case series

Abstract Background Ascaris lumbricoides is one of the most common intestinal infections in developing countries, including Kosovo. In contrast to migration to the bile duct, migration of the worm to the gallbladder, due to the narrow and tortuous nature of the cystic duct, is rare. When it does occur, it incites acalculous cholecystitis. Case presentations This case series describes a 16-month-old Albanian girl, a 22-month-old Albanian girl, a 4-year-old Albanian girl, and a 10-year-old Albanian boy. Here we report our experience with gallbladder ascariasis including clinical manifestations, diagnostic procedures, and treatment. Fever, diarrhea and vomiting, dehydration, pale appearance, and weakness were the manifestations of the primary disease. In all patients, a physical examination revealed reduced turgor and elasticity of the skin. Abdomen was at the level of the chest, soft, with minimal palpatory pain. The liver and spleen were not palpable. A laboratory examination was not specific except for eosinophilia. There were no pathogenic bacteria in coproculture but Ascaris was found in all patients. At an ultrasound examination in all cases we found single, long, linear echogenic structure without acoustic shadowing containing a central, longitudinal anechoic tube with characteristic movement within the gallbladder. Edema of the gallbladder wall was suggestive of associated inflammation. There were no other findings on adjacent structures and organs. All patients received mebendazole 100 mg twice a day for 3 days. They also received symptomatic therapy for gastroenteritis. Because of elevated markers of inflammation all patients were treated with antibiotics, assuming acute cholecystitis, although ultrasound was able to confirm cholecystitis in only two of our four patients. Since the length of stay was dependent on the primary pathology it was 7 to 10 days. At control ultrasounds on 14th day, third and sixth month, all patients were free of ascariasis. Conclusions Gallbladder ascariasis should be considered in all patients presenting with abdominal pain, distension, colic, nausea, anorexia, and intermittent diarrhea associated with jaundice, nausea, vomiting, fever, and severe radiating pain. Eosinophilia, ova, and parasites on stool examination as well as an anechogenic tube with characteristic movement within the bile duct found on abdominal ultrasound are conclusive for diagnosis. Mebendazole is an effective drug for the treatment. Surgical treatment is rarely needed