Service design methods

U radu je opisana tema metoda dizajna usluga te je naglasak stavljen na Osterwalderovu metodu dizajna usluga. Isto tako, Osterwalderov poslovni model primijenjen je na stvarnom poduzeću te je objašnjen idealan poslovni model na istom primjeru

Effect of "Baby-friendly hospital" initiative on changes in attitudes of health care professionals on delivery

Ciljevi: Primarni cilj bio je utvrditi da li su i u kolikoj mjeri zdravstveni djelatnici promijenili pristup prema primjeni epiziotomije kod normalnog porođaja, što se smatra promjenom pristupa koji je uvjetovan između ostaloga i inicijativom „Rodilište-prijatelj djece“. Sekundarni ciljevi rada bili su utvrditi promjene u učestalosti primjene epiduralne analgezije za olakšanje porođajne boli, učestalost primjene infuzije oksitocina za poticanje napredovanja porođaja (aktivno vođenje porođaja), učestalost amniotomije kao metode ubrzanja porođaja te broj instrumentalno dovršenih porođaja. Ispitanici i metode: Faktorima uključenja i isključenja definirane su dvije promatrane skupine ispitanica koje su rodile 1993. i 2015. godine. Iz analize smo isključili sve žene koje su tijekom trudnoće imale gestacijski dijabetes, gestacijsku hipertenziju, placentu previu, bilo kakva krvarenja tijekom trudnoće, plod u stavu zatkom te bilo kakve druge kronične i akutne bolesti koje bi mogle utjecati na ishod trudnoće. Podaci su prikupljeni retrospektivno. Provedena je deskriptivna analiza podataka te su testirane razlike između skupina korištenjem z-testa za proporcije. Pohrana i obrada podataka učinjena je u programu Microsoft Excel TM. Razina statističke značajnosti bila je p ≤ 0,05. Rezultati: Usporedbom rezultata za 1993. i 2015. godinu utvrdili smo značajnu razliku u broju učinjenih epiziotomija (z=6.5513). Uz pouzdanost od 95% zaključili smo da se 2015. godine pri porođajima značajno više koristila epiduralna analgezija. Usporedbom infuzije oksitocina utvrđena je značajna razlika (uz značajnost od 95%) između 1993. i 2015. godine kada je u pitanju udio porođaja kod kojih je korištena infuzija oksitocina. Pri tome je veća zastupljenost infuzije oksitocina bila u 2015. godini. Kod izvedene amniotomije, kao i u broju instrumentalno dovršenih porođaja uz vakum ekstrakciju nije bilo statistički značajne razlike. Nije dokazana statistički značajna razlika u trajanju duljine porođaja. Statistički značajna razlika uočena je u duljini boravka majke i novorođenčadi u rodilištu. (p<0.01, t=6,157) Zaključak: Ovim provedenim istraživanjem zaključili smo da je inicijativa „Rodilište – prijatelj djece“ utjecala na pozitivnu promjenu u pristupu zdravstvenih djelatnika prema primjeni epiziotomije kod vaginalnih porođaja.Aims: The primary aim was to determine if and in what way did health care prefessionals change their approach towards episiotomy practice in normal labour, which is considered to be influenced, among other things, by the «Baby-friendly hospital» initiative. Secundary aims were to ascertain the prevalence of epidural analgesia for alleviating labour pain, the prevalence of oxytocin infusion for labour augmentation (active labour management), the prevalence of amniotomies performed for labour augmentation as well as the number of instrumentally assisted labours. Material and methods: Two groups of pregnant women who gave birth in 1993 and 2015 were selected and compared according to inclusion and exclusion criteria. The study excluded pregnancies burdened with gestational diabetes, gestational hypertension, placenta praevia, any form of bleeding during pregancy, breech praesentation or any other acute or chronic condition that might influence labour outcome. Data were collected retrospectivly from medical records. Descriptive statistical analysis was performed and difference between variables was tested using z-test for proportions. Data processing was performed in Microsoft Excel TM. Statistical significance was considered p<0.05. Results: Comparision of results from 1993 and 2015 showed a statistically significant difference in the number of episiotomies performed (z=6.5513). With an accuracy of 95% the results showed that significantly more labours in 2015 included epidural analgesia and oxytocin infusion. No statisitcal difference was found in the number of amniotomies or instrumentally assisted labours between 1993 and 2015 as well as in labour duration. the results showed a statistically significant difference in the time mothers and newborns spent in hospital after delivery (p<0.01, t=6,157). Conclusion: It can be concluded that the «Baby-friendly hospital» initiative has influenced positively to the approach of health care professionals towards episiotomy practice in normal, vaginal deliveries

Bell OH-58D Kiowa Warrior Helicopter Heat Signature Determination

Moderni oblici sukoba i ratovanja zahtijevaju široki raspon taktičke eksploatacije izvidničko – borbenih helikoptera. Veličine bojišta se smanjuju, ali zbog urbanog ratovanja, nemogućnosti definiranja točne crte razgraničenja i sve veće prisutnosti civilnog stanovništva, povećava se složenost borbenih zadaća. U nejasnim i složenim područjima povećava se opasnost od toplinsko navođenih protuzračnih sustava, stoga je potrebno, na temelju mjerenja toplinskog odraza helikoptera OH-58D, definirati načine smanjenja rizika s taktičkog gledišta. Cilj istraživanja je procjena stvarne ugroze od toplinsko navođenih protuzračnih sustava na helikopteru OH-58D, definiranje manevara i taktičkih radnji u području djelovanja prije i u slučaju neposredne ugroze.Modern forms of conflict and warfare require a wide spectrum of tactical exploitation of scout – attack helicopters. Battlefield sizes are reduced, but due to urban warfare, the impossibility of defining the exact line of delimitation and the growing presence of civilan population increases the complexity of combat tasks. In the unclear and complex areas, the risk of heat – seeking antiaircraft systems increases, so it is necessary, based on the OH-58D helicopters heat signature, to define ways of reducing risk from a tactical point of view. The aim of the research is to esimate the real threat to the OH-58D helicopters by defining maneuvers and tactics in the area of action before and in the event of immediate threats

Service design methods

U radu je opisana tema metoda dizajna usluga te je naglasak stavljen na Osterwalderovu metodu dizajna usluga. Isto tako, Osterwalderov poslovni model primijenjen je na stvarnom poduzeću te je objašnjen idealan poslovni model na istom primjeru

Effect of "Baby-friendly hospital" initiative on changes in attitudes of health care professionals on delivery

Ciljevi: Primarni cilj bio je utvrditi da li su i u kolikoj mjeri zdravstveni djelatnici promijenili pristup prema primjeni epiziotomije kod normalnog porođaja, što se smatra promjenom pristupa koji je uvjetovan između ostaloga i inicijativom „Rodilište-prijatelj djece“. Sekundarni ciljevi rada bili su utvrditi promjene u učestalosti primjene epiduralne analgezije za olakšanje porođajne boli, učestalost primjene infuzije oksitocina za poticanje napredovanja porođaja (aktivno vođenje porođaja), učestalost amniotomije kao metode ubrzanja porođaja te broj instrumentalno dovršenih porođaja. Ispitanici i metode: Faktorima uključenja i isključenja definirane su dvije promatrane skupine ispitanica koje su rodile 1993. i 2015. godine. Iz analize smo isključili sve žene koje su tijekom trudnoće imale gestacijski dijabetes, gestacijsku hipertenziju, placentu previu, bilo kakva krvarenja tijekom trudnoće, plod u stavu zatkom te bilo kakve druge kronične i akutne bolesti koje bi mogle utjecati na ishod trudnoće. Podaci su prikupljeni retrospektivno. Provedena je deskriptivna analiza podataka te su testirane razlike između skupina korištenjem z-testa za proporcije. Pohrana i obrada podataka učinjena je u programu Microsoft Excel TM. Razina statističke značajnosti bila je p ≤ 0,05. Rezultati: Usporedbom rezultata za 1993. i 2015. godinu utvrdili smo značajnu razliku u broju učinjenih epiziotomija (z=6.5513). Uz pouzdanost od 95% zaključili smo da se 2015. godine pri porođajima značajno više koristila epiduralna analgezija. Usporedbom infuzije oksitocina utvrđena je značajna razlika (uz značajnost od 95%) između 1993. i 2015. godine kada je u pitanju udio porođaja kod kojih je korištena infuzija oksitocina. Pri tome je veća zastupljenost infuzije oksitocina bila u 2015. godini. Kod izvedene amniotomije, kao i u broju instrumentalno dovršenih porođaja uz vakum ekstrakciju nije bilo statistički značajne razlike. Nije dokazana statistički značajna razlika u trajanju duljine porođaja. Statistički značajna razlika uočena je u duljini boravka majke i novorođenčadi u rodilištu. (p<0.01, t=6,157) Zaključak: Ovim provedenim istraživanjem zaključili smo da je inicijativa „Rodilište – prijatelj djece“ utjecala na pozitivnu promjenu u pristupu zdravstvenih djelatnika prema primjeni epiziotomije kod vaginalnih porođaja.Aims: The primary aim was to determine if and in what way did health care prefessionals change their approach towards episiotomy practice in normal labour, which is considered to be influenced, among other things, by the «Baby-friendly hospital» initiative. Secundary aims were to ascertain the prevalence of epidural analgesia for alleviating labour pain, the prevalence of oxytocin infusion for labour augmentation (active labour management), the prevalence of amniotomies performed for labour augmentation as well as the number of instrumentally assisted labours. Material and methods: Two groups of pregnant women who gave birth in 1993 and 2015 were selected and compared according to inclusion and exclusion criteria. The study excluded pregnancies burdened with gestational diabetes, gestational hypertension, placenta praevia, any form of bleeding during pregancy, breech praesentation or any other acute or chronic condition that might influence labour outcome. Data were collected retrospectivly from medical records. Descriptive statistical analysis was performed and difference between variables was tested using z-test for proportions. Data processing was performed in Microsoft Excel TM. Statistical significance was considered p<0.05. Results: Comparision of results from 1993 and 2015 showed a statistically significant difference in the number of episiotomies performed (z=6.5513). With an accuracy of 95% the results showed that significantly more labours in 2015 included epidural analgesia and oxytocin infusion. No statisitcal difference was found in the number of amniotomies or instrumentally assisted labours between 1993 and 2015 as well as in labour duration. the results showed a statistically significant difference in the time mothers and newborns spent in hospital after delivery (p<0.01, t=6,157). Conclusion: It can be concluded that the «Baby-friendly hospital» initiative has influenced positively to the approach of health care professionals towards episiotomy practice in normal, vaginal deliveries

Ja sam primalja

U ovom eseju opisano je osobno iskustvo primalje čiji je posao svakodnevno pomagati ženama da na svijet donesu novi život. Kao primalja svakodnevno u svom radu svjedočim radosti rađanja. Babica sam više od trideset godina i svaki novi plač i prvi udah djeteta iznova me pune energijom i podsjećaju zašto sam odabrala baš ovaj humani poziv. Za mene je bila posebna sreća što sam bila primalja na porodu svoje kćeri i porodila svoju unuku. U ovom radu iznijela sam pitanja koja su me mučila tijekom kćerkine trudnoće, a na kraju sam opisala sreću jer sam uspjela ujediniti uloge primalje, majke i bake odjedno

Interventions for treating hyperemesis gravidarum.

BACKGROUND: Hyperemesis gravidarum is a severe form of nausea and vomiting in pregnancy affecting 0.3% to 1.0% of pregnancies, and is one of the most common indications for hospitalization during pregnancy. While a previous Cochrane review examined interventions for nausea and vomiting in pregnancy, there has not yet been a review examining the interventions for the more severe condition of hyperemesis gravidarum. OBJECTIVES: To assess the effectiveness and safety, of all interventions for hyperemesis gravidarum in pregnancy up to 20 weeks\u27 gestation. SEARCH METHODS: We searched the Cochrane Pregnancy and Childbirth Group\u27s Trials Register and the Cochrane Complementary Medicine Field\u27s Trials Register (20 December 2015) and reference lists of retrieved studies. SELECTION CRITERIA: Randomized controlled trials of any intervention for hyperemesis gravidarum. Quasi-randomized trials and trials using a cross-over design were not eligible for inclusion.We excluded trials on nausea and vomiting of pregnancy that were not specifically studying the more severe condition of hyperemesis gravidarum. DATA COLLECTION AND ANALYSIS: Two review authors independently reviewed the eligibility of trials, extracted data and evaluated the risk of bias. Data were checked for accuracy. MAIN RESULTS: Twenty-five trials (involving 2052 women) met the inclusion criteria but the majority of 18 different comparisons described in the review include data from single studies with small numbers of participants. The comparisons covered a range of interventions including acupressure/acupuncture, outpatient care, intravenous fluids, and various pharmaceutical interventions. The methodological quality of included studies was mixed. For selected important comparisons and outcomes, we graded the quality of the evidence and created \u27Summary of findings\u27 tables. For most outcomes the evidence was graded as low or very low quality mainly due to the imprecision of effect estimates. Comparisons included in the \u27Summary of findings\u27 tables are described below, the remaining comparisons are described in detail in the main text.No primary outcome data were available when acupuncture was compared with placebo, There was no clear evidence of differences between groups for anxiodepressive symptoms (risk ratio (RR) 1.01, 95% confidence interval (CI) 0.73 to 1.40; one study, 36 women, very low-quality evidence), spontaneous abortion (RR 0.48, 95% CI 0.05 to 5.03; one study, 57 women, low-quality evidence), preterm birth (RR 0.12, 95% CI 0.01 to 2.26; one study, 36 women, low-quality evidence), or perinatal death (RR 0.57, 95% CI 0.04 to 8.30; one study, 36 women, low-quality evidence).There was insufficient evidence to identify clear differences between acupuncture and metoclopramide in a study with 81 participants regarding reduction/cessation in nausea or vomiting (RR 1.40, 95% CI 0.79 to 2.49 and RR 1.51, 95% CI 0.92 to 2.48, respectively; very low-quality evidence).In a study with 92 participants, women taking vitamin B6 had a slightly longer hospital stay compared with placebo (mean difference (MD) 0.80 days, 95% CI 0.08 to 1.52, moderate-quality evidence). There was insufficient evidence to demonstrate a difference in other outcomes including mean number of episodes of emesis (MD 0.50, 95% CI -0.40 to 1.40, low-quality evidence) or side effects.A comparison between metoclopramide and ondansetron identified no clear difference in the severity of nausea or vomiting (MD 1.70, 95% CI -0.15 to 3.55, and MD -0.10, 95% CI -1.63 to 1.43; one study, 83 women, respectively, very low-quality evidence). However, more women taking metoclopramide complained of drowsiness and dry mouth (RR 2.40, 95% CI 1.23 to 4.69, and RR 2.38, 95% CI 1.10 to 5.11, respectively; moderate-quality evidence). There were no clear differences between groups for other side effects.In a single study with 146 participants comparing metoclopramide with promethazine, more women taking promethazine reported drowsiness, dizziness, and dystonia (RR 0.70, 95% CI 0.56 to 0.87, RR 0.48, 95% CI 0.34 to 0.69, and RR 0.31, 95% CI 0.11 to 0.90, respectively, moderate-quality evidence). There were no clear differences between groups for other important outcomes including quality of life and other side effects.In a single trial with 30 women, those receiving ondansetron had no difference in duration of hospital admission compared to those receiving promethazine (MD 0.00, 95% CI -1.39 to 1.39, very low-quality evidence), although there was increased sedation with promethazine (RR 0.06, 95% CI 0.00 to 0.94, low-quality evidence) .Regarding corticosteroids, in a study with 110 participants there was no difference in days of hospital admission compared to placebo (MD -0.30, 95% CI -0.70 to 0.10; very low-quality evidence), but there was a decreased readmission rate (RR 0.69, 95% CI 0.50 to 0.94; four studies, 269 women). For other important outcomes including pregnancy complications, spontaneous abortion, stillbirth and congenital abnormalities, there was insufficient evidence to identify differences between groups (very low-quality evidence for all outcomes). In other single studies there were no clear differences between groups for preterm birth or side effects (very low-quality evidence).For hydrocortisone compared with metoclopramide, no data were available for primary outcomes and there was no difference in the readmission rate (RR 0.08, 95% CI 0.00 to 1.28;one study, 40 women).In a study with 80 women, compared to promethazine, those receiving prednisolone had increased nausea at 48 hours (RR 2.00, 95% CI 1.08 to 3.72; low-quality evidence), but not at 17 days (RR 0.81, 95% CI 0.58 to 1.15, very low-quality evidence). There was no clear difference in the number of episodes of emesis or subjective improvement in nausea/vomiting. There was insufficient evidence to identify differences between groups for stillbirth and neonatal death and preterm birth. AUTHORS\u27 CONCLUSIONS: On the basis of this review, there is little high-quality and consistent evidence supporting any one intervention, which should be taken into account when making management decisions. There was also very limited reporting on the economic impact of hyperemesis gravidarum and the impact that interventions may have.The limitations in interpreting the results of the included studies highlights the importance of consistency in the definition of hyperemesis gravidarum, the use of validated outcome measures, and the need for larger placebo-controlled trials

Plan istraživanja utjecaja uvođenja standardnog operativnog postupka u kliničku praksu rodilišta na određeni klinički ishod

Bol i oštećenje bradavica prilikom dojenja (tzv. ragade) povezani su sa ranim prestankom dojenja te pojavom postporođajne depresije. Bol i ragade su često smatrane integralnim dijelom dojenja i neminovnošću, no istraživanja pokazuju da se pravovremenom intervencijom medicinskog osoblja oni mogu spriječiti. Pravovremena intervencija lakša je uz unaprijed definirane standardne operativne postupke čije uvođenje u kliničku praksu dokazano poboljšava kliničke ishode. Ovaj rad prikazuje plan istraživanja kojem je cilj utvrditi učinkovitost uvođenja standardnog operativnog postupka u smanjenju broja ragada u cilju prevencije ranog prestanka dojenja