Agency for quality and accreditation of the health care facilities

The Agency ensures quality and safety in health care through the process of accreditation and re-accreditation of the health care facilities. The Agency develops, revise and improves the standards of the health care in HC facilities, monitors the implementation of the standards and facilitates the preparedness of the HC facility for successful external assessment

Evidence based pediatrics.

It is very difficult to define the entire phrase “Evidence based pediatrics”, covering all components of this overused sentence. The definition comes out of the common sentence and it means integration of the individual clinical expertize together with the best external clinically available evidence of the systematic reviews which are of interest and benefit of the individual patient.Development of clinically appropriate structured question follows PICO model, i.e. containing following components: P=paients; I=intervention; C=comparison (standard treatment, placebo, nothing) and O=outcome. For each type of questions a systematic review of all available studies is better than any individual study. The search could be performed using Boolean operators (A or B, A and B, A not B). The rationale for using systematic reviews is minimizing bias (of the reviewer, and in the research studies themselves), enhancement of the precision by including all the relevant evidence; putting results into context by examining conflicts and understanding differences; helping in prioritizing the research by knowing exactly what has been done, how well, and with what findings. Part of the systematic review is the metaanalysis, which represents statistical analysis of a large collection of results from individual studies for the purpose of integrating the findings

WHO Technical Consultation on Postpartum and Postnatal Care

Публикација од техничкиот серијал на СЗО за ревизија на Клиничките упатства на светско ниво во областа на перинатологијата. Главен консултнт од областа на неонатологија и автор на тој дел е проф д-р Зисовска, и нејзината систематички преглед е печатен во публикација на СЗ

Perinatal Health Care Improvement in Macedonia Through Education: Case Study

The Official Macedonian Reports on the situation in the field of perinatal health care showed for a longer period high rates in perinatal/neonatal mortality which ranked the country in the bottom of the list of European countries. It required urgent Strategy for improvement the efficiency of perinatal care services in Macedonia in late 1990-ties. The main issues within the strategy were: prevention and health promotion, training and education, infrastructure, equipment supply, institutional and organizational change and policies and procedures. The example of Macedonia emphasized the role and the value of the education and training and health education in highly successful implementation of the National strategy for perinatal care improvement. The most appropriate learning startegies and methods of assessment were chosen in order to get the best scores in theoretical and practical sense. The greatest achievement was the overall decrease of 27% in the Perinatal Mortality Rate, compared 3 years before intervention with 2 years after starting intervention (27.4 to 21.5 per 1000 births) and decrease of 36% in early neonatal deaths in babies >1000g (12.0 to 7.7 per 1000 live births), reflecting the postnatal thrust of the program. The process of change management in perinatal health care was kept along implementing the standards, and the results were published as “successful story” in the final Report after the evaluation, prepared by the external consultant Prof Dr Heather Jeferry and submitted to the Ministry of Health of the Republic of Macedonia

Underlying cause of neonatal macrosomia

Background: High blood sugar levels (BSL) in pregnant could be a reason for macrosomia. The aim of our study was to present some indicators in LGA babies related to maternal diabetes. Methods: This was a cohort prospective study conducted in the first six months in 2020 at the University Clinic for Gynecology and Obstetrics in Skopje, North Macedonia. The identification of the LGA newborns was according to WHO growth standards for both sexes. Results: 108 LGA newborns, divided into three groups: A-36 LGA babies (33,3%) whose mothers had no history of Diabetes; B-14 LGA babies (12,9%) of mothers with pre-gestational Diabetes; C-56 LGA babies (51,6%) of mothers with Gestational diabetes were examined. Glycaemia was taken according to the National Guidelines (30 minutes after the second feed). The results showed significantly lower BSL in group C, mean 1,6±0,2 mmol/L (OR 2.19, 95% CI, 1.25–3.82, P=0.01). Both groups of newborns (A and B) had no significant difference in the mean value of BSL. The ratio of male/female was significantly higher in group A (1,4) compared to the other two groups, suggesting that associated factors other than diabetes are responsible for the macrosomia. The results showed that LGA babies have a much higher risk if their mothers have gestational diabetes compared to pre-existing diabetes, or with those whose mothers had no history or parameters of diabetes. Conclusion: The impact of gestational diabetes during pregnancy depends on early identification and good management

Few building blocks for evidence-based decision making

“Health Governance” refers to policy agenda setting processes, implementation and accountability within the health sector. It includes the management and administration of policies and resources in health, including processes for health systems strengthening. “Governance for Health” describes a far more multifaceted and complex process of intersectoral collaboration and policy agenda setting, formulation, implementation and accountability whereby multiple sectors, groups of actors and levels of action collaborate and intertwine with the goal of fostering equitable health development. “Governance for Health” thus involves a large number of stakeholders in policy processes and transcends the boundaries of not only specific sectors (e.g. health, trade) but also ‘levels’ of governance (i.e. local, national, regional, international). Evidence-based medicine (EBM) is an approach to medical practice intended to optimize decision-making by emphasizing the use of evidence from well designed and conducted research. Although all medicine based on science has some degree of empirical support, EBM goes further, classifying evidence by its strength and requiring that only the strongest types (coming from meta-analyses, systematic reviews, and randomized controlled trials) can yield strong recommendation

Перинатална кардиореспираторна физиологија

Прво и основно разбирање на спецификите во анатомијата и физиологијата на новороденчето е дека тоа ниту е „мал возрасен човек”, ниту пак „мало дете”. Повеќе органи и системи имаат единствени, уникатни специфики кај новороденчето, а познавањето на нивната анатомија и физиологија е од интерес за реанимацијата, водењето на анестезијата, и администрирањето на терапија. Сите органи и органски системи претрпуваат еден период на прилагодување, но од функционален аспект, најмногу промени трпат респираторниот систем, кардиоваскуларниот систем, терморегулацијата, имунолошкиот и ензимскиот систем

Alpha Glutathione S-transferase – A Potential Biomarker for Intestinal Epithelial Damage in Infants with Acute Gastroenteritis

BACKGROUND: Acute gastroenteritis is a leading cause of morbidity and mortality in children under 3 years of age worldwide and mostly can be dangerous in the first 12 months of life especially in infants who are not exclusively breastfed. Intestinal pathogens cause enterocyte infection which leads to cell death, lumen extrusion, and intestinal villous atrophy. AIM: The aim of this study was to assess whether alpha glutathione S-transferase (α-GST) can be a biomarker for early intestinal epithelial damage in infants with acute gastroenteritis and the degree of correlation of its serum values with the degree of intestinal epithelial damage associated with infant nutrition. MATERIALS AND METHODS: A total of 23 infants with acute gastroenteritis divided into two groups based on the feeding patterns (type of milk) were included in the study. The values of α-GST in serum between exclusively breastfed and non-exclusively breastfed infants were examined. RESULTS: It was found a statistically significant association between group affiliation and the α-GST levels in serum between the first and the second group (p = 0.002260). It was revealed that Rotavirus can cause erosion of the intestinal epithelium through the positive values of α-GST in Rotavirus positive cases. CONCLUSION: In this study, it was found that α-GST is a biomarker for early intestinal epithelial damage in infants primarily with Rotavirus acute gastroenteritis. α-GST serum values were significantly lower in infants who were exclusively breastfed compared with infants who were not exclusively breastfed

Facial Expression and Physiological Changes in Newborns Following Procedural Pain

All healthy human beings feel pain and they express it in different ways. Some researchers elaborate that the newborns do

Perinatal Health Care Improvement in Macedonia Through Education: Case Study

The Official Macedonian Reports on the situation in the field of perinatal health care showed for a longer period high rates in perinatal/neonatal mortality which ranked the country in the bottom of the list of European countries. It required urgent Strategy for improvement the efficiency of perinatal care services in Macedonia in late 1990-ties. The main issues within the strategy were: prevention and health promotion, training and education, infrastructure, equipment supply, institutional and organizational change and policies and procedures. The example of Macedonia emphasized the role and the value of the education and training and health education in highly successful implementation of the National strategy for perinatal care improvement. The most appropriate learning startegies and methods of assessment were chosen in order to get the best scores in theoretical and practical sense. The greatest achievement was the overall decrease of 27% in the Perinatal Mortality Rate, compared 3 years before intervention with 2 years after starting intervention (27.4 to 21.5 per 1000 births) and decrease of 36% in early neonatal deaths in babies >1000g (12.0 to 7.7 per 1000 live births), reflecting the postnatal thrust of the program. The process of change management in perinatal health care was kept along implementing the standards, and the results were published as “successful story” in the final Report after the evaluation, prepared by the external consultant Prof Dr Heather Jeferry and submitted to the Ministry of Health of the Republic of Macedonia