The quality of the tear film in glacuoma patients after phacoemulsification surgery

Introduction: Glaucoma is a chronic disease that requires permanent topical drug therapy. The negative effects of eye drops on the ocular surface may be due to the action of the active ingredient or preservative. The most commonly used preservative is benzalkonium chloride which is a detergent and then polyquad which is its derivative

Checklists as a standard of patient safety in the healthcare process

Kvalitetna zdravstvena skrb je osnovno pravo svakog pojedinca i kao takvo se spominje i u brojnim dokumentima koji se odnose na prava pacijenata te ljudska prava. Jedna od sastavnica kvalitete zdravstvene zaštite jest i upravljanje rizicima. Utvrdilo se da svaki deseti pacijent doživi medicinsku pogrešku. Iako su uzroci medicinskih pogrešaka vrlo raznoliki, vodeći je razlog medicinskih pogrešaka manjkava komunikacija među zdravstvenim osobljem ili između zdravstvenog osoblja i bolesnika/članova obitelji. Kako bi se izbjegle zamke manjkave komunikacije, a s ciljem unaprjeđenja kvalitete zdravstvene zaštite, razvijene su kontrolne liste – jedan od najpoznatijih alata kojima se poboljšava komunikacija te time i smanjuje učestalost propusta koji su mogli biti spriječeni.Quality healthcare is a basic right of every individual and as such is mentioned in numerous documents related to both patients’ rights and human rights. One of the components of health care quality is risk management. It was found that every tenth patient experiences a medical error. Although the causes of medical errors are very diverse, the leading cause of medical errors is poor communication among healthcare staff or between healthcare staff and patients/family members. In order to avoid the pitfalls of poor communication, and to improve the quality of health care, checklists were developed – one of the best-known tools for improving communication and thereby reducing the frequency of errors that could have been prevented

Patient identification and prevention of patient misidentification as a standard of patient safety in health care process

Sigurnost bolesnika je jedna od osnovnih smjernica za kvalitetno provođenje zdravstvene skrbi. Povećanje sigurnosti sustava zdravstvene zaštite rezultira nižom stopom neželjenih događaja, čime su bolesnici sigurniji od pogrešaka koje im se mogu dogoditi u zdravstvenom sustavu. Jedan od mogućih neželjenih događaja u sustavu zdravstvene zaštite jest zamjena identiteta bolesnika. Iako se često problemom zamjene identiteta bolesnika bavimo tek nakon što se takav neželjeni događaj već zbio, ključno je te događaje spriječiti. Postoje brojni načini koji se mogu primijeniti kako bi se smanjio rizik od zamjene identiteta bolesnika. Izbor odgovarajućeg načina sprječavanja zamjene identiteta bolesnika i mogućnost implementacije u svakodnevnu praksu te upotreba elektroničkih sustava ovise o specifičnosti samog sustava u kojem se određeni način za sprječavanje zamjene identiteta bolesnika planira primijeniti. Također, razvijanje i njegovanje kulture sigurnosti jedan je od ključnih čimbenika za sprječavanje zamjene identiteta bolesnika. Svijest i bolesnika i osoblja o važnosti provjere identiteta najvažniji su čimbenik u sprječavanju zamjene identiteta bolesnika. Prijavljivanje problema povezanih s točnom identifikacijom bolesnika, prijavljivanje zamjene identiteta bolesnika koja se dogodila ili se skoro dogodila (engl. near miss events) te njihova analiza ključni su za sprječavanje tih događaja u budućnosti.Patient safety is one of the basic guidelines for high-quality implementation of healthcare. Increasing the safety of the health care system results in a lower rate of unwanted events, which makes patients safer from mistakes that can happen to them in the health care system. One of the possible unwanted events in the health care system is patient misidentification. Although we often deal with the problem of patient misidentification only after such unwanted event has already taken place, it is crucial to prevent it from happening. There are a number of ways to reduce the risk of patient misidentification. The choice of the most appropriate way for the prevention of patient misidentification, the possibility of implementation in everyday practice, as well as the use of electronic systems depend on the specificity of the system itself in which a certain method is planned to be applied. Also, the development and the nurturing of safety culture is one of the key factors for preventing patient misidentification. The awareness of both patients and staff about the importance of identity confirmation is the most important factor in the prevention of patient misidentification. The reporting of problems related to accurate patient identification, as well as the reporting of near miss events and their analysis are key to preventing these events in the future

The presence of high mobility group box-1 and soluble receptor for advanced glycation end-products in juvenile idiopathic arthritis and juvenile systemic lupus erythematosus

BACKGROUND: The involvement of high mobility group box-1 (HMGB1) in various inflammatory and autoimmune diseases has been documented but clinical trials on the contribution of this pro-inflammatory alarmin in children with juvenile idiopathic arthritis (JIA) and systemic lupus erythematosus (SLE) are basically absent. To address the presence of HMGB1 and a soluble receptor for advanced glycation end products (sRAGE) in different subtypes of JIA and additionally in children with SLE, we enrolled a consecutive sample of children harvested peripheral blood as well as synovial fluids (SF) at diagnosis and correlated it with ordinary acute-phase reactants and clinical markers. ----- METHODS: Serum and synovial fluids levels of HMGB1 and sRAGE in total of 144 children (97 with JIA, 19 with SLE and 27 healthy controls) were determined by ELISA. ----- RESULTS: The children with JIA and those with SLE were characterised by significantly higher serum levels of HMGB1 and significantly lower sRAGE levels compared to the healthy controls. A positive correlation between serum HMGB1 and ESR, CRP, α2 globulin was found while serum sRAGE levels were inversely correlated with the same inflammatory markers in children with JIA. Additionally, high level of serum HMGB1 was related to hepatosplenomegaly or serositis in systemic onset JIA. ----- CONCLUSION: The inverse relationship of the HMGB1 and its soluble receptor RAGE in the blood and SF indicates that inflammation triggered by alarmins may play a role in pathogenesis of JIA as well as SLE. HMGB1 may serve as an inflammatory marker and a potential target of biological therapy in these patients. Further studies need to show whether the determination of HMGB1 levels in patients with JIA can be a useful guideline for detecting disease activity

Risk factors for recurrent vulvovaginal candidiasis

Background/Aim. Recurrent vulvovaginal candidiasis is relatively frequent condition, and may have serious health consequences, like chronic vulvovaginal pain syndrome. The aim of our study was to determine possible risk factors for recurrent vulvovaginal candidiasis in non-pregnant females within the reproductive age. Methods. The design of our study was of a case-control type. Case and control patients were selected from the gynecological patients at six primary care facilities in Serbia and in Montenegro. The data on the patients' health condition, concomitant therapy and diseases were taken from their records, and the data on habits were obtained by unstructured interview. For potential risk factors crude odds ratios were calculated, and then adjusted by logistic regression. Results. A total of fifty-one patients had four or more episodes of vulvovaginal candidiasis during the last year (cases), and 132 patients with one to three episodes of vulvovaginal candidiasis were sampled as controls, matched by age. The only two significant associations were found between recurrent vulvovaginal candidiasis and continual wearing of panty liners during the last year (Odds ratio - ORadjusted: 3.97; confidence interval - CI: 1.57-10.02; p = 0.004), and between recurrent vulvovaginal candidiasis and predominant use of vaginal tampons during menstruation in the last year (ORadjusted: 4.25; CI: 1.11-16.27; p = 0.035). The synergistic effect was observed for the concurrent continual wearing of panty liners during the last year and selfmedication with antimycotics. Conclusions. Local factors, like wearing of panty liners or use of tampons during menstruation, may promote recurrence of vulvovaginal candidiasis, especially in patients who practice selfmedication with antimycotics

Kontrolne liste kao standard sigurnosti bolesnika u procesu zdravstvene skrbi

Kvalitetna zdravstvena skrb je osnovno pravo svakog pojedinca i kao takvo se spominje i u brojnim dokumentima koji se odnose na prava pacijenata te ljudska prava. Jedna od sastavnica kvalitete zdravstvene zaštite jest i upravljanje rizicima. Utvrdilo se da svaki deseti pacijent doživi medicinsku pogrešku. Iako su uzroci medicinskih pogrešaka vrlo raznoliki, vodeći je razlog medicinskih pogrešaka manjkava komunikacija među zdravstvenim osobljem ili između zdravstvenog osoblja i bolesnika/članova obitelji. Kako bi se izbjegle zamke manjkave komunikacije, a s ciljem unaprjeđenja kvalitete zdravstvene zaštite, razvijene su kontrolne liste – jedan od najpoznatijih alata kojima se poboljšava komunikacija te time i smanjuje učestalost propusta koji su mogli biti spriječeni

Identifikacija bolesnika i sprječavanje zamjene identiteta kao standard sigurnosti bolesnika u procesu zdravstvene skrbi

Sigurnost bolesnika je jedna od osnovnih smjernica za kvalitetno provođenje zdravstvene skrbi. Povećanje sigurnosti sustava zdravstvene zaštite rezultira nižom stopom neželjenih događaja, čime su bolesnici sigurniji od pogrešaka koje im se mogu dogoditi u zdravstvenom sustavu. Jedan od mogućih neželjenih događaja u sustavu zdravstvene zaštite jest zamjena identiteta bolesnika. Iako se često problemom zamjene identiteta bolesnika bavimo tek nakon što se takav neželjeni događaj već zbio, ključno je te događaje spriječiti. Postoje brojni načini koji se mogu primijeniti kako bi se smanjio rizik od zamjene identiteta bolesnika. Izbor odgovarajućeg načina sprječavanja zamjene identiteta bolesnika i mogućnost implementacije u svakodnevnu praksu te upotreba elektroničkih sustava ovise o specifičnosti samog sustava u kojem se određeni način za sprječavanje zamjene identiteta bolesnika planira primijeniti. Također, razvijanje i njegovanje kulture sigurnosti jedan je od ključnih čimbenika za sprječavanje zamjene identiteta bolesnika. Svijest i bolesnika i osoblja o važnosti provjere identiteta najvažniji su čimbenik u sprječavanju zamjene identiteta bolesnika. Prijavljivanje problema povezanih s točnom identifikacijom bolesnika, prijavljivanje zamjene identiteta bolesnika koja se dogodila ili se skoro dogodila (engl. near miss events) te njihova analiza ključni su za sprječavanje tih događaja u budućnosti

Public-Private Partnerships: Interorganizational Design as Key Success Factor

Public-Private Partnership (PPP), as a current topic in theory and practice, has mostly been treated from the perspective of legislation and recognized by classical macroeconomic paradigm. The aim of this paper is to open a new aspect of dealing with this topic, both organizational and managerial. The paper underlines the importance of organizational design in a PPP, because experience has shown that without strong organization, coordination, defined rules and principles, there is no successful outcome and initiatives amount to a failed attempt. This is why interorganizational relations require well defined organizational architecture where it is clearly determined who, what, how and by when needs to deliver. In a PPP, this is achieved through a contractual framework and the creation of a special purpose company (SPC). The paper also affirms a new managerial position - PPP Manager - that apart from the general managerial skills and knowledge needs to be specialised in managing PPPs