MENADŽMENT RIZIKA U PROCESU KLINIČKE ZDRAVSTVENE NJEGE

Risk management in the process of nursing clinical practice is a systematic process that requires expertise and skills in risk prevention. Patient safety at the hospital is the primary goal of every individual providing health care service, and at the same time of the organizations. Accordingly, it is necessary to develop strategies that minimize the risks in the hospital and successfully address adverse events in practice. The main hypothesis was that risk management in the healthcare process has a positive impact on the quality and safety of healthcare service. The following goals were set: 1) to identify the most common risks reported in the healthcare process; 2) to examine the ways and models of risk prevention in the healthcare process in hospitals; and 3) to examine the practice and attitude of nurses in the process of managing risks and adverse events. The survey was conducted among 115 nurses/medical technicians employed at the public health institutions-hospitals in the Federation of Bosnia and Herzegovina. The survey used the original questionnaire prepared by the authors in the electronic Google forms, which was available to the respondents via personal e-mail address, and they responded completely independently without the infl uence of another person. Comparison of risk events in practice showed a statistically signifi cant decrease with advancing age of the respondents (rho=-0.274; p=0.003), longer work experience of the respondents (rho=-0.334; p=0.0001), higher education of the respondents (rho=-0.198; p=0.034), conducting patient categorization (rho=-0.289; p=0.002), and policies and procedures adopted (rho=-0.408; p=0.0001). A statistically signifi cant effect on reducing the number of adverse events per patient was shown for the frequency of examination of patient skin and mucous membranes during hospital stay (rho=-0.200; p=0.032), use of scales to assess the risk of falls (rho=-0.422; p=0.0001), use of risk assessment scales for pressure ulcers (rho=-0.375; p=0.0001), frequency of intravenous cannula replacement (rho=-0.204; p=0.029), frequency of patient bathing (rho=-0.355; p= 0. 0001) and the method of performing nutritional evaluation of artifi cially fed patients (rho=-0.327; p=0.0001). In conclusion, patient safety in the hospital should be considered a paramount issue, and nurses who spend most time with patients are expected to provide conditions for secure hospital stay, conditions for safe and quality service in the health care process, and implementation of standardized procedures based on scientifi c and practical evidence. Continuous reporting of quality indicators in the health care process contributes to strengthening of the organizational culture, prevention of risks and adverse events, and planning of personnel and equipment necessary for the quality of the health care process.Upravljanje rizicima u procesu sestrinske kliničke prakse je sistematičan proces koji zahtijeva stručnost i vještine u prevenciji nastanka rizika. Sigurnost bolesnika u bolnici je primarni cilj svakog pojedinca koji pruža zdravstvenu uslugu, a istodobno i same organizacije. U skladu s time neophodno je razviti strategije kojima će rizici u bolnici biti svedeni na minimum i kojima će se uspješno riješiti neželjeni događaji u praksi. Glavna hipoteza rada bila je da upravljanje rizicima u procesu zdravstvene njege ima pozitivan utjecaj na kvalitetu i sigurnost zdravstvenih usluga. Ciljevi rada bili su: 1. Utvrditi najčešće rizike koji se prijavljuju u procesu zdravstvene njege; 2. Ispitati načine i modele prevencije rizika u procesu zdravstvene njege u bolnicama; 3. Ispitati praksu i stav medicinskih sestara u procesu upravljanja rizicima i neželjenim događajima. Istraživanje je provedeno među 115 medicinskih sestara-tehničara zaposlenih u javnim zdravstvenim ustanovama, bolnicama u FBiH. U istraživanju je primijenjen originalni autorski anketni upitnik pripremljen u elektroničkom programu Google forms koji je ispitanicima bio dostupan putem osobne adrese e-pošte, a na njega su odgovarali potpuno samostalno bez utjecaja druge osobe. Usporedba rizičnih događaja u praksi pokazuje statistički značajno smanjenje u odnosu na stariju dob ispitanika (rho=-0,274; p=0,003), duži radni staž ispitanika (rho=-0,334; p=0,0001), višu stručnu spremu ispitanika (rho=-0,198; p=0,034), provođenje kategorizacije bolesnika (ro=-0,289; p=0,002), usvojene politike i postupke (rho=-0,408; p=0,0001). Na smanjenje broja neželjenih događaja za bolesnika statistički značajan utjecaj pokazali su: učestalost pregleda kože i sluznica bolesnika za vrijeme hospitalizacije (rho=-0,200; p=0,032), uporaba ljestvica za procjenu rizika od pada (rho=-0,422; p=0,0001), uporaba ljestvica za procjenu rizika za nastanak dekubitusa (rho=-0,375; p=0,0001), učestalost promjene intravenske kanile (ro=-0,204; p=0,029), učestalost kupanja bolesnika (rho=-0,355; p=0,0001) i način nutritivne procjene bolesnika koji se hrane umjetnim putem (rho=-0,327; p=0,0001). U zaključku, sigurnost bolesnika u bolnici treba biti na prvom mjestu, a od medicinskih sestara koje najviše vremena provode uz bolesnike očekuje se osiguranje uvjeta za siguran smještaj u bolničkom prostoru, uvjeta za sigurnu i kvalitetnu uslugu u procesu zdravstvene njege te primjenu standardiziranih postupaka osnovanih na znanstvenim dokazima i dokazima iz prakse. Kontinuirano izvještavanje o indikatorima kvalitete u procesu zdravstvene njege doprinosi jačanju organizacijske kulture, prevenciji rizika i neželjenih događaja te planiranju kadrova i opreme neophodne za kvalitetu procesa zdravstvene njege

Upravljanje dokumentacijom zdravstvene njege u bolničkim uvjetima

Healthcare documentation or nursing documentation as often used in practice is the name of an indispensable part of a patient’s medical documentation, and documentation is an integral part of a nurse’s daily work. Documenting health care in the hospital means recording data on all procedures performed, during the entire health care process for the individual, all for the purpose of systematic monitoring, planning and evaluation of the quality of health care. Nursing documentation serves as a means of communication between the team and is of great importance for the quality and continuity of health care. AIMS: 1 - To determine the existence of health care documentation in hospital health care institutions; 2 - Examine the importance and purpose of documenting health care among nurses-medical technicians; 3 - Examine the practice of nurses-medical technicians in the process of administering health care; 4 - Present quality indicators that are monitored and analyzed through health care documentation; 5 - Compare the obtained results in two examined areas. METHODS: This research was conducted in two geographically separate areas of Sarajevo and Travnik. The study involved 210 respondents, 147 nurses-technicians employed at the Clinical Center of the University of Sarajevo and 63 nurses-technicians employed at the General Hospital in Travnik. Data collection for research was carried out by exploratory and descriptive method. An original authorized questionnaire was used for the descriptive research. The questionnaire was made available to respondents in the electronic form trough Google Forms. The anonymity of the respondents was fully guaranteed. The survey was conducted in the period from July 15- August 15, 2019. RESULTS: At the Clinical Center of the University of Sarajevo (CCU), 98% of respondents use health care documentation forms on a daily basis, and at the General Hospital Travnik 77.8% of respondents. In CCU Sarajevo, respondents use more standardized forms of health care documentation, 97.6%, compared to respondents in the General Hospital Travnik, where the documenting is carries out in nursing records, 74.6%. 68% of respondents at CCU Sarajevo believe that documentation contributes to the evaluation of nursing services, while only 19% of re-spondents at General Hospital Travnik believe the same. As the most common shortcomings, the respondents state the lack of computer technology in the department in 74.3%, then adequate premises for document administration in 37.6%, the lack of forms in printed form in 32.1% and 6 or 2.3% respondents did not answer this question. In both institutions, the biggest shortcoming is the problem of computer equipment in the department, in 70.7% in CCU Sarajevo and 82.5% in General Hospital Travnik. CONCLUSIONS: The research found that over 95% of respondents use standardized health care processes in their daily practice, document health care, know the basic purpose and monitor health care indicators. More than 90% of respondents in both study groups use health care documentation to plan health care and monitor its outcomes. More than half of respondents in both study groups stated that documenting health care is a problem because it consumes a lot of time. A larger number of respondents from both groups, as many as 30%, state that they do not use the data from the health care documentation for any purpose. The lack of workers in the health care process, insufficient knowledge of information technologies, and the lack of an information system represent an aggravating circumstance in documenting the health care process.Dokumentacija zdravstvene njege ili sestrinska dokumentacija, kako se često naziva u praksi, neizostavan je dio medicinske dokumentacije pacijenta, a dokumentiranje je sastavni dio svakodnevnoga sestrinskog posla. Dokumentiranje zdravstvene njege u bolnici podrazumijeva zapisivanje podataka o svim provedenim postupcima tijekom cjelokupnog procesa zdravstvene njege za pojedinca, a sve u svrhu sustavnog praćenja stanja te planiranja i vrednovanja kvaliteta zdravstvene njege. Sestrinska dokumentacija služi kao sredstvo komunikacije između tima i od velike je važnosti za kvalitetu i kontinuitet zdravstvene njege. CILJEVI RADA: 1. Utvrditi postojanje dokumentacije zdravstvene njege u bolničkim zdravstvenim ustanovama. 2. Ispitati praksu medicinskih sestara/tehničara u procesu administriranja zdravstvene njege. 3. Prikazati indikatore kvalitete koji se prate i analiziraju putem dokumentacije zdravstvene njege. 4. Komparirati dobivene rezultate u dva ispitivana područja. METODE RADA: Ovo istraživanje provedeno je na dva geografski odvojena područja, u Sarajevu i Travniku. U istraživanju je sudjelovalo 210 ispitanika, i to 147 medicinskih sestara/tehničara zaposlenih u Kliničkom centru Univerziteta u Sarajevu i 63 medicinske sestre / medicinska tehničara zaposlena u Općoj bolnici u Travniku. Prikupljanje podataka za istraživanje provedeno je deskriptivnom metodom. Za deskriptivno istraživanje primijenjen je originalni autorski upitnik. Upitnik je ispitanicima bio dostupan u elektroničkom obliku u internetskoj aplikaciji Google Forms. Anonimnost ispitanika bila je u potpunosti zajamčena. Istraživanje je provedeno u periodu od 15. srpnja do 15. kolovoza 2019. REZULTATI ISTRAŽIVANJA:U Kliničkom centru Univerziteta u Sarajevu 98 % ispitanika svakodnevno upotrebljava obrasce dokumentacije zdravstvene njege, a u Općoj bolnici Travnik 77,8 % ispitanika. U KCU-u Sarajevo ispitanici više upotrebljavaju standardizirane obrasce dokumentacije zdravstvene njege, i to 97,6 %, u odnosu na ispitanike u Općoj bolnici u Travniku, gdje se dokumentiranje vrši u sestrinske evidencijske bilježnice, i to 74,6 %. 68 % ispitanika u KCU-u Sarajevo smatra da dokumentiranje pridonosi vrednovanju sestrinskih usluga, dok to smatra samo 19 % ispitanika iz Opće bolnice Travnik. Kao najčešće nedostatke ispitanici navode nedostatak računalne tehnike na odjelu (74,3 %), zatim neadekvatne prostorije za administriranje dokumentacije (37,6 %) te nedostatak obrazaca u tiskanom obliku (32,1 %), a na ovo pitanje nije odgovorilo šest ili 2,3 % ispitanika.U obje ustanove kao najveći nedostatak navode problem računalne opreme na odjelu, i to 70,7 % u KCU-u Sarajevo i 82,5 % u OB-u Travnik. ZAKLJUČCI: Istraživanjem je utvrđeno da više od 95 % ispitanika u svakodnevnoj praksi primjenjuje standardizirane procese zdravstvene njege, dokumentira zdravstvenu njegu, poznaje osnovnu svrhu i prati indikatore zdravstvene njege. Više od 90 % ispitanika u obje ispitivane skupine dokumentacijom zdravstvene njege kori-sti se za planiranje zdravstvene njege i praćenje njezinih ishoda.Više od polovine ispitanika u obje ispitivane skupine navelo je da im dokumentiranje zdravstvene njege predstavlja problem jer im oduzima mnogo vremena u radu. Veći broj ispitanika obje ispitivane skupine, čak 30 %, navodi da se podacima iz dokumentacije zdravstvene njege ne koriste ni u kakve svrhe. Nedostatak izvršitelja procesa zdravstvene njege, nedovoljno znanje o informacijskim tehnologijama te nepostojanje informacijskog sustava predstavlja otežavajuću okolnost u dokumentiranju procesa zdravstvene njege

Relationship between reduced exposure to estrogen over a lifetime and bone mineral density in postmenopausal women

Introduction: The influence and interactions of various genetic, hormonal, environmental and nutritional factors and risks for decreased bone mineral density in older age are not yet clear. The aim of this study was to examine relationship between reduced exposure to estrogen over a lifetime (early age at menopause, shorter period between menarche and menopause) and bone mineral density in older women. Methods: A total of 60 women, aged 60-75 years were included and assigned to osteoporosis group (n=30), or control group with normal bone mineral density or osteopenia (n=30). The values ​​of bone mineral density were obtained by dual energy X-ray absorptiometry (DXA) at the lumbar spine (L2-L4) and proximal femur. Results: Women with osteoporosis entered the menopause at a younger age (43.03±3.18 years) compared to women without osteoporosis (51.93± 2.30 years) and the difference was statistically significant, p=0.0001. In addition, women with osteoporosis had shorter timespan between menarche and menopause (28.33±3.31 years), compared to women without osteoporosis (38.43±2.48 years), which was statistically significant, p=0.0001. Conclusion: Reduced exposure to estrogen over a lifetime because of early menopause, and shorter timespan between menarche and menopause may be associated with decreased bone mineral density and osteoporosis in postmenopausal women

Neoadjuvant Chemotherapy Affects TFF3 Peptide Expression in Luminal B Subtype of Breast Cancer – A Pilot Study

Aim: Trefoil factor family 3 (TFF3) peptide is normally expressed by epithelial cells in breast ducts, but it is also associated with different pathological conditions, including breast cancer. It is considered a marker of poor prognosis and associated with increased resistance to chemotherapy. Data on the effect of chemotherapy on TFF3 peptide expression are scarce. The aim of this pilot study was to assess suitability of research on this topic for large-scale studies. Methods: Formalin-fixed, paraffin-embedded samples of core biopsies and of surgically removed tumors from patients with luminal B subtype of breast cancer were used for immunohistochemical analysis. Changes in TFF3 peptide and Ki-67 expression and microvessel density (MVD) values before and after chemotherapy were analyzed, as well as the association between TFF3 peptide expression and Ki-67 expression and MVD values. Results: Significant reduction in TFF3 and Ki 67 expression was observed after chemotherapy, while MVD values did not differ significantly before and after chemotherapy. The association of TFF3 peptide expression and Ki-67 expression and TFF3 peptide expression and MVD values was not significant before or after chemotherapy. Conclusion: The data obtained in this pilot study suggest that a large-scale study is justified, and it other breast cancer subtypes should be included. (Bijelić N, Abramović M, Rajc J, Rođak E, Marušić Z, Tolušić Levak M, Pauzar B, Belovari T. Neoadjuvant Chemotherapy Affects TFF3 Peptide Expression in Luminal B Subtype of Breast Cancer – A Pilot Study. SEEMEDJ 2020; 4(2); 20-27

Managing Fuel Consumption and Emissions in the Renewed Fleet of a Transport Company

This research shows the relationship between the energy emission parameters and CO2 equivalents for conventional fossil fuel-powered vehicles (ICEV, Internal Combustion Engine Vehicles) and hybrid electric vehicles (HEV) to determine the life cycle costs of the vehicles. The combination of transport policy and alternative fuels has the purpose of creating a sustainable transport system. Transport policy focuses on increasing energy efficiency and reducing the price of electric vehicles as technology advances. The profitability for each vehicle type was also observed through current vehicle purchase prices. The main objective of this paper is to study the environmental impact of diesel vans, taking into account lifelong energy use, fuel consumption and CO2 equivalents through air pollution. Although the purchase price of the ICEV is less than the HEV, all electric vehicles are determined to have the lowest overall environmental impact during the operational phase. The goal of transport companies and logistics operators that own a fleet is to achieve quality service with maximum cost and negative environmental impact reduction

MENADŽMENT RIZIKA U PROCESU KLINIČKE ZDRAVSTVENE NJEGE

Risk management in the process of nursing clinical practice is a systematic process that requires expertise and skills in risk prevention. Patient safety at the hospital is the primary goal of every individual providing health care service, and at the same time of the organizations. Accordingly, it is necessary to develop strategies that minimize the risks in the hospital and successfully address adverse events in practice. The main hypothesis was that risk management in the healthcare process has a positive impact on the quality and safety of healthcare service. The following goals were set: 1) to identify the most common risks reported in the healthcare process; 2) to examine the ways and models of risk prevention in the healthcare process in hospitals; and 3) to examine the practice and attitude of nurses in the process of managing risks and adverse events. The survey was conducted among 115 nurses/medical technicians employed at the public health institutions-hospitals in the Federation of Bosnia and Herzegovina. The survey used the original questionnaire prepared by the authors in the electronic Google forms, which was available to the respondents via personal e-mail address, and they responded completely independently without the infl uence of another person. Comparison of risk events in practice showed a statistically signifi cant decrease with advancing age of the respondents (rho=-0.274; p=0.003), longer work experience of the respondents (rho=-0.334; p=0.0001), higher education of the respondents (rho=-0.198; p=0.034), conducting patient categorization (rho=-0.289; p=0.002), and policies and procedures adopted (rho=-0.408; p=0.0001). A statistically signifi cant effect on reducing the number of adverse events per patient was shown for the frequency of examination of patient skin and mucous membranes during hospital stay (rho=-0.200; p=0.032), use of scales to assess the risk of falls (rho=-0.422; p=0.0001), use of risk assessment scales for pressure ulcers (rho=-0.375; p=0.0001), frequency of intravenous cannula replacement (rho=-0.204; p=0.029), frequency of patient bathing (rho=-0.355; p= 0. 0001) and the method of performing nutritional evaluation of artifi cially fed patients (rho=-0.327; p=0.0001). In conclusion, patient safety in the hospital should be considered a paramount issue, and nurses who spend most time with patients are expected to provide conditions for secure hospital stay, conditions for safe and quality service in the health care process, and implementation of standardized procedures based on scientifi c and practical evidence. Continuous reporting of quality indicators in the health care process contributes to strengthening of the organizational culture, prevention of risks and adverse events, and planning of personnel and equipment necessary for the quality of the health care process.Upravljanje rizicima u procesu sestrinske kliničke prakse je sistematičan proces koji zahtijeva stručnost i vještine u prevenciji nastanka rizika. Sigurnost bolesnika u bolnici je primarni cilj svakog pojedinca koji pruža zdravstvenu uslugu, a istodobno i same organizacije. U skladu s time neophodno je razviti strategije kojima će rizici u bolnici biti svedeni na minimum i kojima će se uspješno riješiti neželjeni događaji u praksi. Glavna hipoteza rada bila je da upravljanje rizicima u procesu zdravstvene njege ima pozitivan utjecaj na kvalitetu i sigurnost zdravstvenih usluga. Ciljevi rada bili su: 1. Utvrditi najčešće rizike koji se prijavljuju u procesu zdravstvene njege; 2. Ispitati načine i modele prevencije rizika u procesu zdravstvene njege u bolnicama; 3. Ispitati praksu i stav medicinskih sestara u procesu upravljanja rizicima i neželjenim događajima. Istraživanje je provedeno među 115 medicinskih sestara-tehničara zaposlenih u javnim zdravstvenim ustanovama, bolnicama u FBiH. U istraživanju je primijenjen originalni autorski anketni upitnik pripremljen u elektroničkom programu Google forms koji je ispitanicima bio dostupan putem osobne adrese e-pošte, a na njega su odgovarali potpuno samostalno bez utjecaja druge osobe. Usporedba rizičnih događaja u praksi pokazuje statistički značajno smanjenje u odnosu na stariju dob ispitanika (rho=-0,274; p=0,003), duži radni staž ispitanika (rho=-0,334; p=0,0001), višu stručnu spremu ispitanika (rho=-0,198; p=0,034), provođenje kategorizacije bolesnika (ro=-0,289; p=0,002), usvojene politike i postupke (rho=-0,408; p=0,0001). Na smanjenje broja neželjenih događaja za bolesnika statistički značajan utjecaj pokazali su: učestalost pregleda kože i sluznica bolesnika za vrijeme hospitalizacije (rho=-0,200; p=0,032), uporaba ljestvica za procjenu rizika od pada (rho=-0,422; p=0,0001), uporaba ljestvica za procjenu rizika za nastanak dekubitusa (rho=-0,375; p=0,0001), učestalost promjene intravenske kanile (ro=-0,204; p=0,029), učestalost kupanja bolesnika (rho=-0,355; p=0,0001) i način nutritivne procjene bolesnika koji se hrane umjetnim putem (rho=-0,327; p=0,0001). U zaključku, sigurnost bolesnika u bolnici treba biti na prvom mjestu, a od medicinskih sestara koje najviše vremena provode uz bolesnike očekuje se osiguranje uvjeta za siguran smještaj u bolničkom prostoru, uvjeta za sigurnu i kvalitetnu uslugu u procesu zdravstvene njege te primjenu standardiziranih postupaka osnovanih na znanstvenim dokazima i dokazima iz prakse. Kontinuirano izvještavanje o indikatorima kvalitete u procesu zdravstvene njege doprinosi jačanju organizacijske kulture, prevenciji rizika i neželjenih događaja te planiranju kadrova i opreme neophodne za kvalitetu procesa zdravstvene njege

Isolation and in vitro characterization of novel S. epidermidis phages for therapeutic applications

S. epidermidis is an important opportunistic pathogen causing chronic prosthetic joint infections associated with biofilm growth. Increased tolerance to antibiotic therapy often requires prolonged treatment or revision surgery. Phage therapy is currently used as compassionate use therapy and continues to be evaluated for its viability as adjunctive therapy to antibiotic treatment or as an alternative treatment for infections caused by S. epidermidis to prevent relapses. In the present study, we report the isolation and in vitro characterization of three novel lytic S. epidermidis phages. Their genome content analysis indicated the absence of antibiotic resistance genes and virulence factors. Detailed investigation of the phage preparation indicated the absence of any prophage-related contamination and demonstrated the importance of selecting appropriate hosts for phage development from the outset. The isolated phages infect a high proportion of clinically relevant S. epidermidis strains and several other coagulase-negative species growing both in planktonic culture and as a biofilm. Clinical strains differing in their biofilm phenotype and antibiotic resistance profile were selected to further identify possible mechanisms behind increased tolerance to isolated phages

6th International Conference The Future of Information Sciences INFuture2017: Integrating ICT in Society

This is the sixth publication in the series of biennial international conferences, The Future of Information Sciences (INFuture) organised by the Department of Information and Communication Sciences, Faculty of Humanities and Social Sciences, University of Zagreb. This year it is co-organised with the Miroslav Krleža Institute of Lexicography. The title of the conference is INFuture2017: Integrating ICT in Society. The conference explores the influence the information and communication sciences have on the society as a whole.This is the sixth publication in the series of biennial international conferences, The Future of Information Sciences (INFuture) organised by the Department of Information and Communication Sciences, Faculty of Humanities and Social Sciences, University of Zagreb. This year it is co-organised with the Miroslav Krleža Institute of Lexicography. The title of the conference is INFuture2017: Integrating ICT in Society. The conference explores the influence the information and communication sciences have on the society as a whole

6th International Conference The Future of Information Sciences INFuture2017: Integrating ICT in Society

This is the sixth publication in the series of biennial international conferences, The Future of Information Sciences (INFuture) organised by the Department of Information and Communication Sciences, Faculty of Humanities and Social Sciences, University of Zagreb. This year it is co-organised with the Miroslav Krleža Institute of Lexicography. The title of the conference is INFuture2017: Integrating ICT in Society. The conference explores the influence the information and communication sciences have on the society as a whole.This is the sixth publication in the series of biennial international conferences, The Future of Information Sciences (INFuture) organised by the Department of Information and Communication Sciences, Faculty of Humanities and Social Sciences, University of Zagreb. This year it is co-organised with the Miroslav Krleža Institute of Lexicography. The title of the conference is INFuture2017: Integrating ICT in Society. The conference explores the influence the information and communication sciences have on the society as a whole