Prospective systemic risk analysis of the medicines dispensing process in the community pharmacy setting - perspective of pharmaceutical service quality and patient safety improvement

Izdavanje lekova, jedna od osnovnih aktivnosti u farmaceutskoj praksi, predstavlja proces koji je rizičan i sklon nastanku grešaka, zbog čega potencijalno moţe ugroziti bezbednost pacijenata. Sa porastom nivoa svesti o značaju ovog problema, došlo je i do povećanja broja studija u ovoj oblasti tokom protekle decenije, koje su primarno fokusirane na ispitivanje incidence, tipova i uzroka propusta u izdavanju lekova. Ipak, sa razvojem modernog pristupa medicinskim greškama, u sve većoj meri se naglašava značaj proaktivnog upravljanja rizicima, pre nanošenja štete pacijentu. Primena alata za prospektivnu analizu rizika već je počela u velikom broju procesa zdravstvene zaštite, uključujući izdavanje lekova. Ipak, ove studije se uglavnom sprovode u bolnicama, dok ih na primarnom nivou gotovo uopšte nema, posebno u javnim apotekama, gde se najvećem broju pacijenata vrši izdavanje lekova. Ova doktorska disertacija imala je za cilj sprovoĎenje prospektivnih sistemskih analiza rizika u procesima izdavanja lekova u javnim apotekama u Republici Srbiji i SR Nemačkoj, radi identifikacije potencijalnih grešaka, kvantifikacije i rangiranja prioriteta pridruţenih rizika, kao i definisanja korektivnih mera za smanjenje rizika za bezbednost pacijenata. Cilj je takoĎe bilo sprovoĎenje komparativne analize dobijenih rezultata u Republici Srbiji, kao zemlji u razvoju, i SR Nemačkoj, kao razvijenoj zemlji. Analize načina (oblika) i efekata otkaza (FMEA) su sprovedene u periodu od januara do maja 2016. godine u Republici Srbiji i u oktobru 2016. godine u SR Nemačkoj. Najpre su multidisciplinarni timovi, koji su se sastojali od moderatora i eksperata u izdavanju lekova, primenom tehnike „oluja ideja‖ kreirali dijagram toka analiziranog procesa, i identifikovali potencijalne greške, zajedno sa njihovim uzrocima i posledicama. Zatim je izvršena kvantifikacija pridruţenih rizika, izračunavanjem broja prioriteta rizika (RPN) za svaku potencijalnu grešku, na osnovu njene ozbiljnosti, učestalosti i detektabilnosti. Najzad, definisane su korektivne mere i njihovi potencijalni efekti su procenjeni za greške sa najvišim vrednostima RPN-ova. Identifikovane greške, korektivne mere, kao i potencijal za smanjenje rizika u Republici Srbiji i SR Nemačkoj su zatim uporeĎeni sprovoĎenjem kvalitativne komparativne analize...Dispensing of medicines, one of the central activities in pharmaceutical practice, is considered to be inherently risky and susceptible to errors, thereby posing a constant potential threat to patient safety. Raising awareness of this issue has resulted in an increasing number of studies over the last decade, focusing primarily on the incidence, types and causes of dispensing incidents. However, the modern approach to medication errors emphasizes the importance of proactive risk mitigation, i.e. acting before the patient harm has occurred. The application of prospective risk analyses tools to various health care processes, including dispensing of medicines, has already started. However, these studies are mostly conducted in the hospital setting, while they are almost nonexistent at the primary level of health care, particularly in community pharmacies, where the greatest number of patients are habitually issued medicines. This doctoral dissertation aimed to conduct prospective systemic risk analyses of the medicines dispensing processes in the community pharmacy settings in Serbia and Germany, so as to identify, quantify and prioritize potential failure modes, as well as to define adequate measures for patient safety risk reduction. Furthermore, the aim was to perform a comparative risk analysis of the findings obtained in Serbia, as developing country, and Germany, as developed country. Failure Mode and Effects Analyses (FMEA) were conducted from January to May 2016 in Serbian and in October 2016 in German community pharmacies. First, multidisciplinary teams consisting of a leader and process experts employed brainstorming techniques to map medicines dispensing processes and identify failure modes, along with their causes and effects. Then, the associated risks were quantified by calculating Risk Priority Numbers (RPNs) for each failure mode based on its severity, occurrence and detectability. Finally, corrective actions were developed and their potential effects were evaluated for the failure modes with the highest RPNs. The identified failure modes, corrective actions as well as the potential for risk reduction in Serbia and Germany were further compared by performing qualitative analysis..

Korišćenje društvenih mreža među mladima: Uloga iracionalnih uverenja

Introduction. The use of online social networks has become widespread among the young. Although it may have beneficial effects, it has been established that some people develop problematic or excessive use of social networks which may negatively impact their psychosocial functioning. Objective. The aim of the present study was to investigate social networks use among emerging adults and to explore whether irrational and rational beliefs as conceptualized within the Rational-Emotive & Cognitive-Behavior Therapy (RE&CBT) framework predict problematic social networks use. Following RE&CBT framework, we hypothesized that irrational beliefs are positively, and rational beliefs negatively related to problematic social networks use. Methods. The sample included 210 emerging adults (age range 18–26, M = 21.08, SD = 2.02), 59.0% females. Serbian version of the General Attitude and Belief Scale (SGABS) was used for the assessment of irrational and rational beliefs. Serbian version of Internet Addiction Test was adapted for the assessment of problematic social networks use. Results. The results supported the hypothesis that irrational beliefs are positively related to problematic social networks use. When controlling for intercorrelations between beliefs, demands for love and approval from others stood out as a single significant predictor of problematic social networks use. Rational beliefs were unrelated to problematic social networks use, thus not supporting the hypothesis. Conclusion. The results suggest that RE&CBT approach, which has been proven to be efficacious in prevention of various problems of psychosocial functioning may also provide framework for supporting young people to use social networks in a constructive wayUvod: Korišćenje društvenih mreža na internetu je postalo široko raprostranjeno među mladima. Mada ono može imati povoljne efekte, ustanovljeno je da neke osobe razvijaju problematično ili preterano korišćenje društvenih mreža što može imati negativno dejstvo na njihovo psihosocijalno funkcionisanje. Cilj: Cilj ove studije bio je da se istraži korišćenje društvenih mreža među mladima i da se ispita da li iracionalna i racionalna uverenja shvaćena sa stanovišta racionalno-emocionalne i kognitivno-bihevioralne terapije (RE i KBT) predviđaju problematično korišćenje društvenih mreža. U skladu sa RE i KBT pristupom, pretpostavili smo da su iracionalna uverenja u pozitivnoj, a racionalna uverenja u negativnoj korelaciji sa problematičnim korišćenjem društvenih mreža. Metode: Uzorak je obuhvatio 210 mladih osoba (starosti od 18 do 26 godina, AS = 21.08, SD = 2.02) od kojih je 59.0% ženskog pola. Srpska verzija Skale opštih stavova i uverenja je korišćena za procenu iracionalnih i racionalnih uverenja. Srpska verzija Testa zavisnosti od interneta je prilagođena za procenu problematičnog korišćenja društvenih mreža. Rezultati: U skladu sa pretpostavkom, iracionalna uverenja su u pozitivnoj korelaciji sa problematičnim korišćenjem društvenih mreža. Kada su kontrolisane interkorelacije između uverenja, zahtevi za ljubavlju i odobravanjem od strane drugih su se izdvojili kao jedini značajan prediktor problematičnog korišćenja društvenih mreža. Racionalna uverenja nisu povezana sa problematičnim korišćenjem društvenih mreža, suprotno pretpostavci. Zaključak: Rezultati ukazuju da RE i KBT pristup, koji se pokazao kao delotvoran u prevenciji različitih oblika psihosocijalnih problema, može predstavljati okvir za pružanje podrške mladima da koriste socijalne mreže na konstruktivan nači

Community Pharmacists' Attitudes and Professional Practice in Relation to the Patient Safety Incidents

Background: Medicines dispensing is an error-prone activity, therefore potentially jeopardizing patient safety. This study aimed to assess the community pharmacists' attitudes towards the causes of dispensing errors and preventive measures, as well as their practice in incidents reporting. Materials and Methods: A cross-sectional survey was performed by distributing an adopted and validated questionnaire to a nationwide sample of community pharmacists in Serbia. The questionnaire included sections related to the participants' socio-demographic characteristics, their attitudes towards factors causing dispensing errors and corrective actions, as well as their practice in reporting. Statistical analyses were conducted using SPSS Statistics software ver. 21.0. The associations between categorical variables were analyzed using Chi-square test. Results: The study included 1,004 participants, mainly female (94.9%), with the mean age 40.9 +/- 9.9 years and mean work experience 14.3 +/- 10.0 years. More than a third of the participants (35.4%) indicated an increasing risk of dispensing errors. The main causes included illegible prescriber's handwriting (44.3%) and interruptions during dispensing (39.2%), while the major corrective actions were providing pharmacists with education in clinical pharmacy (71%) and reducing the interruptions during dispensing (63.9%). The majority of respondents (85.2%) stated that they routinely reported dispensing incidents. However, even 16.5% of them admitted to having fear sometimes or always. Additionally, only 58.1% of participants would use voluntary dispensing error reporting system. Conclusion: Serbian community pharmacists are aware of the existing risk in medicines dispensing and the corrective actions identified should be put into practice so as to manage them prospectively. Although the results indicate good practice in incidents reporting, conducting tailored educations and building of safety culture is necessary to improve patient safety

Etički aspekti upotrebe matičnih ćelija kao zdravstvenih tehnologija u personalizovanoj medicini

Objective: Stem cells could be defined as cell with an extraordinary capacity for self-renewal and the ability to differentiate into different cell types. The aim of this study is to examine students' opinion about the use of stem cells as health technologies in disease treatment and radical life extension. Method: Prospective cross-sectional study was conducted as a questionnaire, which was filled anonimly and voluntarily. Results: In this study 655 respondents have participated, with an average age 21.9±}1.8 years. High percentage distribution was concluded with most of the statements, with especially positive attitude towards the preservation of stem cells for their own treatment (84.2%), and treatment of their families (85.4%). Dominantly neutral attitude was expressed according to a statement about the reliability of stem cells and doubts about their implementation.(49.4%).There was no statistically significant difference in students' opinion between different faculties. Conclusion: It is important to evaluate students' opinion because it can obtain information on how the respondents agree with the potential implementation of health technology in the future and, accordingly, whether it is justified to continue further research. We should be more dedicated to informing students in the future, and this type of research should be implemented on a wider population to obtain the relevant results and perform more reliable conclusion.Uvod: Matične ćelije funkcionalno se mogu definisati kao ćelije koje poseduju izvanredni kapacitet samoobnavljanja i sposobnost diferenciranja u različite tipove ćelija. One nisu samo karakarakteristične za embrionalni stadijum razvića individue, već su prisutne i u adultnim tkivima, gde predstavljaju bazu za obnavljanje ćelija tokom života. Zbog toga su kao nove zdravstvene tehnologije tesno povezane sa personalizovanim pristupom lečenju, kao i sa radikalnim produženjem života. Cilj rada: Ispitati stavove studenata u vezi sa upotrebom matičnih ćelija kao zdravstvenih tehnologija u lečenju bolesti i radikalnog produženja života. Metod rada: Sprovedena je prospektivna studija preseka sa namenski kreiranim upitnikom, koji su ispitanici popunjavali anonimno i dobrovoljno. Rezultati: U istraživanju je učestvovalo 655 ispitanika (studenata), prosečne starosti 21,9±}1,8 godina. Utvrđena je visoka procentualna zastupljenost slaganja sa većinom datih izjava i sa naročito pozitivnim stavom prema čuvanju matičnih ćelija za sopstveno lečenje (84,2%), odnosno lečenje svoje porodice (85,4%). Dominantno neutralan stav ispitanika je iskazan prema izjavi o pouzdanosti matičnih ćelija i sumnje u vezi sa njenom primenom (49,4%). Nije utvrđeno postojanje statistički značajne razlike stavova studenata različitih fakulteta ni sa jednom izjavom. Zaključak: Ispitivanje stavova studenata je značajno jer se dobijaju informacije o tome koliko su ispitanici saglasni sa potencijalnom implementacijom zdravstvene tehnologije u budućnosti i shodno tome da li je opravdano nastaviti dalja istraživanja. Rezultati ovog istraživanja su pokazali da su studenti uglavnom saglasni sa čuvanjem matičnih ćelija kako u cilju sopstvenog tako i lečenja članova svoje porodice, ali i da su, nasuprot tome, skeptični po pitanju pouzdanosti u primeni ovih metoda lečenja. U budućnosti bi trebalo posvetiti veću pažnju informisanju studenata i ovaj tip istraživanja je potrebno sprovesti na široj populaciji radi dobijanja što relevantnijih rezultata i izvođenja pouzdanijeg zaključka

Ispitivanje zastupljenosti odabranih faktora rizika za razvoj hipertenzije u populaciji studenata medicinskih fakulteta

Hypertension represents one of the most significant preventable causes of death worldwide, and accordingly the target group for its prevention and early detection primarily refers to young population. Assessment of prevalence of selected risk factors for the development of hypertension among students, and determination of the existence of differences between genders, defined age groups and included faculties. A cross-sectional study was carried out during 2013., at Faculties of Medical Sciences, University of Belgrade. Respondents completed an questionnaire specially designed for the purpose of this study. Categorical data were analyzed using statistical chi-square test of independence. The study included 600 respondents, mainly female (61.2%), with the mean age of 53.1 ± 17.4 years. More than third of the participants (38,6%) reported the genetic predisposition to development of hypertension. Recorded modifiable risk factors were overweight (22,33%), regular extra salt intake (86,3%) and smoking (32,8%). The results of the study indicate presence of reversible risk factors in the observed population. Designing educational programs on chronic diseases during graduate studies is necessary to keep hypertension from developing at older age and mitigate the number of existing risk factors development.Hipertenzija predstavlja jedan od najvažnijih preventabilnih uzroka smrtnosti širom sveta, na osnovu čega ciljnu grupu za njenu prevenciju i ranu detekciju čini pre svega populacija mladih. Ispitivanje zastupljenosti odabranih faktora rizika za razvoj hipertenzije u populaciji studenata, i postojanja razlike među polovima, definisanim starosnim grupama i fakultetima. Studija preseka sprovedena je tokom 2013. godine na fakultetima medicinskih nauka Univerziteta u Beogradu. Ispitanici su popunjavali namenski kreiran upitnik. Kategorički parametri su analizirani primenom statističkog Hi-kvadrat testa nezavisnosti. U studiji je učestvovalo 600 ispitanika prosečne starosti 23.96 ± 2.09 godina, od čega je bilo više osoba ženskog pola (61,2%). Genetsku predispoziciju za razvoj hipertenzije ima više od trećine ispitanika (38,6%). Od prisutnih preventabilnih faktora rizika kao najznačajniji su zabeleženi prekomerna uhranjenost (22.33%), redovan dodatni unos soli kroz konzumaciju slanih grickalica (86,3%) i pušenje (32,8%). Rezultati istraživanja ukazuju na zastupljenost reverzibilnih faktora rizika kod ispitivane populacije. Kako bi se sprečio razvoj hipertenzije u starijem životnom dobu i smanjio broj prisutnih faktora rizika neophodno je razvijanje edukativnih programa o hroničnim bolestima tokom perioda dodiplomskih studija

Perikoncepcijska suplementacija folnom kiselinom - znanja, stavovi i savetodavna praksa farmaceuta i farmaceutskih tehničara u Srbiji

Background/Aim. The protective effect of periconceptional folic acid supplementation in reducing the risk of neural tube defects (NTDs) and other adverse pregnancy outcomes has been scientifically confirmed. The present study aimed to assess knowledge, attitudes, and practice (KAP) of community pharmacists and pharmacy technicians with regards to counselling women of reproductive age on adequate folate intake. Methods. The cross-sectional study was conducted among the nationwide stratified sample of pharmacists and pharmacy technicians, practicing in both private and state-owned community pharmacies in Serbia. The detailed literature review, expert consultation and pre-testing were employed in the questionnaire development. The descriptive and inferential statistical analyses were performed using the SPSS software ver. 22. Results. Among 730 survey participants, 96.6% correctly identified types of deformities that could be prevented by folic acid and 77.0% recognized recommended dosage for women capable of becoming pregnant. However, fewer were able to recognize the optimal timing for folic acid supplementation (61.1%) and the proper dose for the NTD recurrence prevention (42.9 %). While 43.2% of pharmacy technicians thought that it was not their responsibility to provide a counselling concerning the measures for the prevention of congenital anomalies, only 4.7% of licensed pharmacists and none of the interns were of that opinion (χ2 = 198.287; df = 4; p lt 0.001). The majority of respondents (54.7%) reported provision of informative consultation concerning folic acid once a week, or few times a month, while only 10 stated to do so on a daily basis. In addition, based on self-report, only 36.7% of participants communicates information and advice regarding adequate folate status at their own initiative, while the rest addresses this topic only on the patients request, i.e., reactively. Conclusion. Although participants acknowledged the importance of their role in preconception health promotion, our findings revealed certain knowledge gaps as well as dominantly reactive counselling practice. Tailored educational interventions and professional support are needed to improve the engagement of community pharmacy personnel in this area of public health.Uvod/Cilj. Naučno je potvrđen zaštitni efekat primene suplemenata folne kiseline u perikoncepcijskom periodu u redukciji rizika od nastanka defekata nervne cevi (DNC) i drugih neželjenih ishoda trudnoće. Cilj ove studije bio je ispitivanje znanja, stavova i prakse farmaceuta i farmaceutskih tehničara zaposlenih u javnim apotekama u vezi sa savetovanjem žena reproduktivne dobi o adekvatnom unosu folata. Metode. Sprovedenom studijom preseka obuhvaćen je nacionalni stratifikovani uzorak farmaceuta i farmaceutskih tehničara zaposlenih u državnim i privatnim javnim apotekama u Srbiji. Detaljan pregled literature, ekspertske konsultacije i pre-testiranje primenjeni su u procesu razvoja upitnika. Deskriptivna i inferencijalna statistička analiza realizovane su primenom SPSS softvera ver. 22. Rezultati. Od 730 ispitanika, 96,6% tačno je identifikovalo vrste deformiteta koji se mogu prevenirati primenom folne kiseline, a 77,0% prepoznalo je preporučenu dozu za žene sposobne da ostanu u drugom stanju. Ipak, manji udeo ispitanika prepoznao je optimalni vremenski okvir za suplementaciju (61,1%), kao i adekvatnu dozu za prevenciju rekurence DNC (42,9%). Dok je 43,2% farmaceutskih tehničara izrazilo uverenje da nije njihova obaveza da sprovode savetovanje o merama za prevenciju kongenitalnih anomalija, takvo mišljenje imalo je samo 4,7% licenciranih farmaceuta i nijedan farmaceut-stažer (χ2 = 198.287; df = 4; p lt 0,001). Većina učesnika studije (54,7%) izjavila je da pruža informativne konsultacije u vezi folne kiseline jednom nedeljno ili nekoliko puta mesečno, a samo 10 ispitanika tvrdilo je da to čini svakodnevno. Dodatno, na osnovu sopstvenog izveštaja, samo 36,7% ispitanika pruža savete i informacije o adekvatnom statusu folata na sopstvenu inicijativu, dok ostatak ovu temu pominje samo na zahtev pacijenta tj. reaktivno. Zaključak. Iako su ispitanici prepoznali značaj sopstvene uloge u promociji zdravlja u prekoncepcijskom periodu, naši rezultati ukazali su na određene propuste u znanju i dominantno reaktivan pristup savetovanju. Prilagođene edukativne intervencije i profesionalna podrška neophodni su za unapređenje javnozdravstvenog angažovanja farmaceutskog tima iz javnih apoteka u ovoj oblasti

Farmakoekonomska evaluacija pružanja farmaceutske usluge pacijentima na antikoagulantnoj terapiji varfarinom

It has been determined that Pharmacist-Managed Anticoagulation Service (PMAS) for patients on warfarin improves anticoagulation control and decreases the rate of bleeding, thus reducing the overall health care costs. This study aims to compare the cost-effectiveness of providing pharmaceutical care (PC) and usual medical care (UMC) to patients on warfarin, from the perspective of the National Health Insurance Fund (NHIF) in Serbia. The cost-effectiveness analysis was conducted, with a time horizon of 10 days. Decision tree modeling combined data on efficacy from eligible studies, while the costs were taken from NHIF Drug and Service fee lists. Additionally, the budget impact analysis was performed, aiming to project annual savings by implementing PMAS as a part of anticoagulation clinics. PC has been perceived to be cost-effective strategy, since it enables a higher probability of well controlled INR value (additional effectiveness 0,154), along with lower costs (-374,51 RSD), compared to UMC. Negative incremental cost-effectiveness ratio additionally demonstrated cost-effectiveness of PC, as dominant strategy. Sensitivity analysis confirmed the model robustness, and budget impact analysis has also demonstrated significant annual savings, in the total amount of 50.863.313 RSD for a five year period 2016-2020. Providing PC to patients on warfarin represents a more cost-efficient strategy than UMS, in addition to better safety profile, which is why it should be implemented in the national health care system in the future.Utvrđeno je da sprovođenje menadžmenta terapije varfarinom od strane farmaceuta značajno unapređuje kontrolu antikoagulacije i smanjuje broj slučajeva krvarenja, a time i pridružene troškove lečenja. Cilj ovog rada je farmakoekonomska evaluacija pružanja farmaceutske zdravstvene zaštite (FZZ) pacijentima na varfarinu u odnosu na standardnu zdravstvenu zaštitu (SZZ), iz perspektive Republičkog fonda za zdravstveno osiguranje (RFZO). Sprovedena je analiza isplativosti primenom drveta odlučivanja, za period od 10 dana. U modelu su kombinovani podaci za posmatrane ishode iz odgovarajućih studija, dok su direktni medicinski troškovi preuzeti iz važećih cenovnika zdravstvenih usluga, kao i Liste lekova RFZO. Dodatno je sprovedena analiza uticaja na budžet, radi projektovanja potencijalnih ušteda u slučaju implementacije ove farmaceutske usluge. FZZ je troškovno isplativija strategija, obzirom na veću efektivnost (+0,154), a manji trošak (-374,51 RSD) u odnosu na SZZ. Negativna vrednost inkrementalnog odnosa troškova i efektivnosti za FZZ dodatno potvrđuje njenu isplativost, kao dominantne strategije. Analiza osetljivosti je potvrdila robusnost modela, dok su analizom uticaja na budžet projektovane značajne uštede, od 50.863.313 RSD za petogodišnji period 2016.-2020. Pružanje FZZ pacijentima na antikoagulantnoj terapiji varfarinom predstavlja troškovno-isplativiju strategiju u odnosu na SZZ u Republici Srbiji, zbog čega je poželjno da se implementira u nacionalni zdravstveni sistem u budućnosti

8-Iso-prostaglandin F2α as a potential biomarker in patients with unipolar and bipolar depression

Objective: Previous studies have shown that the disturbance of redox homeostasis plays a role in the pathogenesis of mood disorders. It is currently unclear whether oxidative stress parameters can be used as biomarkers (state vs. trait). The aim of the present study was to investigate oxidative stress markers in patients with major depressive disorder (MDD) and bipolar disorder (BP) in acute depressive episodes and remission, and healthy individuals. Patients and methods: Thirty-two patients with a diagnosis of MDD, 32 patients with a diagnosis of BP and 32 matched healthy controls were included in the study. We measured the serum levels of markers of oxidative damage, including 8-hydroxy-2'-deoxyguanosine (8-OHdG), 8-Iso-prostaglandin F2α (8-iso-PGF2α; 8-isoprostane), and malondialdehyde (MDA), and also serum activities of superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GPX), and glutathione reductase (GR) in both acute and remission phase, and in control group. Results: After controlling for the effects of age, sex, body mass index, and smoking status, serum 8-iso-PGF2α levels were significantly higher in both patient groups compared to controls, regardless of disease phase. The activities of GPX and GR were significantly lower in the acute phase in MDD patients compared to controls. Serum GR activity was lower in both acute and remission phase in MDD compared to BP. Conclusions: Our results suggest that both MDD and BP are associated with a disturbed redox balance with a particularly pronounced increase in serum 8-iso-PGF2α levels in both groups and the presence of glutathione metabolism disorders in MDD patients. Further research is needed to confirm the importance of oxidative stress parameters as potential biomarkers of MDD and BP

Chemical composition and biological properties of Pelargonium graveolens, Leptospermum petersonii and Cymbopogon martinii var. motia essential oils and of Rosa centifolia absolute

Chemical composition of the essential oils (EO) of Pelargonium graveolens, Leptospermum petersonii and Cymbopogon martinii var. motia, and the absolute of Rosa centifolia and their bioactivity were examined. Major compounds in P. graveolens EO were monoterpene alcohols citronellol, geraniol and linalool; in L. petersonii EO monoterpene aldehydes geranial, neral and citronellal; in C. martiniii var. motia EO monoterpene alcohol geraniol and ester geranyl acetate, while in absolute of R. centifolia aromatic alcohol 2-phenylethanol. The EO of L. petersonii showed the strongest antibacterial while the EO of C. martinii var. motia the strongest antifungal potential. The best biofilm inhibition capacity was observed with R. centifolia absolute. The results of scanning electron microscopy analysis indicated that the EOs of L. petersonii and P. graveolens changed the number and morphology of C. albicans cells. The L. petersonii EO was the most potent toward tumour cells and exhibited the best biological activity. This is first comparative report summarizing efficacy of studied aromatic samples against pathogenic microbes, providing deeper insight into the modes of antimicrobial action, and at the same time describing their cytotoxicity against cell lines.The authors are grateful to the Ministry of Education, Science and Technological Development of Serbia (Grants No. 451-03-9/2021-14/200007 and 451-03-9/2021-14/200003).info:eu-repo/semantics/publishedVersio

Bezbednost bolesnika i medicinske greške u procesu pružanja zdravstvene zaštite - izazovi za savremenu praksu

Non-maleficence represents one of the basic ethical principles that health care providers should be guided by during service delivery. Establishment of patient safety is nowadays recognized as an issue of global concern in health care and a critical component of quality management. The aim of this paper is to provide a literature review of the patient safety and medication errors concept, with special attention given to defining the most significant terms, analyzing the causal factors and reviewing their classification. Raising awareness about the importance of patient safety has resulted in an increase in the number of medication error studies over the last decade. The traditional approach which makes health workers responsible for reduction of incidents is replaced by the modern concept which implies the involvement of all stakeholders at all levels of the system. In developed countries, the application of prospective risk management models for specific health care processes has already started. However, all these studies are mainly carried out at the secondary and tertiary levels of health care, while they are almost non-existent at the primary level. In the Republic of Serbia, a Rulebook on indicators of the quality of health care has been recently adopted, but a trend of significant lack of data regarding patient safety can be noticed due to inadequate reporting. It is necessary to continue with the homogenization of terminology and to increase the number of analyses of causal factors with the aim of prospective risk identification, particularly in developing countries such as the Republic of Serbia.Neškodljivost predstavlja jedan od osnovnih etičkih principa kojim bi trebalo da se rukovode zdravstveni radnici prilikom pružanja usluga zdravstvene zaštite. Uspostavljanje i unapređenje bezbednosti bolesnika danas je prepoznato kao problem od globalnog značaja u zdravstvu i kritična komponenta upravljanja kvalitetom. Cilj ovog rada bio je literaturni prikaz koncepta bezbednosti bolesnika i medicinskih grešaka, sa posebnim osvrtom na pregled definicija najznačajnijih termina u ovoj oblasti, analizu faktora koji determinišu nastanak medicinskih grešaka i razmatranje njihove klasifikacije. Tokom poslednje decenije je sa povećanjem svesti o problemu bezbednosti bolesnika povećan i broj istraživanja medicinskih grešaka. Tradicionalni pristup po kome su za redukciju incidenata i poboljšanje bezbednosti odgovorni zdravstveni radnici zamenjuje se savremenim konceptom, koji podrazumeva uključivanje svih aktera na svim sistemskim nivoima radi upravljanja rizicima prilikom pružanja zdravstvenih usluga. U razvijenim zemljama je započeta i primena prospektivnih modela upravljanja rizicima za određene procese u zdravstvenoj zaštiti. Međutim, sve ove studije se uglavnom sprovode na sekundarnom i tercijarnom nivou zdravstvene zaštite, dok ih na primarnom nivou gotovo uopšte nema. U Republici Srbiji je nedavno usvojen Pravilnik o pokazateljima kvaliteta zdravstvene zaštite, ali se uprkos implementaciji regulative, može uočiti trend značajnog nedostatka podataka u vezi sa bezbednošću bolesnika zbog neadekvatnog prijavljivanja od strane zdravstvenih ustanova. U budućnosti je neophodno nastaviti sa homogenizacijom terminologije, kao i povećati broj ispitivanja faktora koji doprinose nastanku medicinskih grešaka, a sa ciljem prospektivnog identifikovanja i prevencije rizika u sistemu zdravstvene zaštite, a posebno u zemljama u razvoju kao što je Republika Srbija