Application of Wound Closure Molndal Technique after Laparoscopic Cholecystectomy – Initial Comparative Study

Because of a possible delayed wound healing, critical colonization and infection of wounds present a problem for surgeons1–3. Colonized and infected wounds are a potential source for cross-infection1–3. Molndal technique of wound dressing has proven to be effective in prevention of infection. Also the wound heal better and faster3–5. In our study we wanted to describe the benefits of the Molndal technique wound dressing after laparoscopic cholecistectomy compared to traditional wound dressing technique. Molndal technique consisted of wound dressing with Aquacel Ag – Hydrofiber (ConvaTec, Dublin, Ireland). Traditional technique was performed using gauze compresses and hypoallergic adhesives. We analyzed the results of 100 patients after laparoscopic cholecystectomy. 50 patients were treated by Molndal technique and 50 patients by the traditional technique of wound dressing. In the group trated by Molndal technique only 1 (2%) patient has revealed a wound infection, proven by positive microbiological examination and suppuration, mostly in the subumbilical incision. In the traditional technique group 7 (14%) patients developed wound infection also predominantly in the subumbilical incision. The difference was statistically significant (p<0.01). Our results are clearly showing that Molndal technique is effective in preventing the infection of subumbilical incision wound and is to by recommend for regular use at designated site after laparoscopic cholecistectomy

Hip Fractures in Elderly – Ten Years Analysis

Geriatric hip fractures (GHP) are the major problem in the geriatric traumatology and it is estimated that treatment of GHF will spend a large amount of health care resources1–5. The aim of this retrospective study was to compare differences in incidence of operatively treated patients with GHF, type of treatment depending of the type of fracture, early postoperative mortality, length of stay and costs of used implants within a 10 years period. Surgically treated 2478 patients, older than 65 years with hip fractures were included in the study. Patients were grouped according to the type of fracture (femoral neck fracture or intertrochanteric femoral fracture) and used implant. Results showed increasing trend in GHF in our County in the last 10 years. There was a shifting trend in used implants, and new surgical techniques were used more commonly in the last few years. In observed period there were no significant changes in revision surgery and length of hospital stay. The mortality decreased, especially in males, but generally it was not in correlation with used implant. At the 10-years period increase in patients with GHF of 179% was followed with 4 time higher increase in implant prices. Present reimbursement in health care system does not calculate the difference of implant costs in hospital expenses, therefore proper usage of modern implants and careful planning in the treatment of GHF is necessary

Nurse attitudes in Croatia towards primary resuscitation of prematurely born infants

CILJ: Cilj istraživanja bilo je ispitati stavove medicinskih sestara u Hrvatskoj o primarnom oživljavanju prijevremeno rođene djece. METODE: Pisanom anketom ispitivana je dob, roditeljstvo, radno iskustvo i mjesto rada te stavovi medicinskih sestara iz Hrvatske o primarnom oživljavanju prijevremeno rođene djece. Anketirano je 174 medicinskih sestara; 49 zaposlenih u rađaonici ili na mjestima rada sa trudnicama (Rađ/Tr), 79 u pedijatrijskim/ neonatološkim jedinicama intenzivnog liječenja (JIL/NICU), 46 na radnom mjestu sa općom populacijom (OP). REZULTATI: Nije bilo statistički značajne razlike među skupinama u odnosu na dob, materinstvo i duljinu radnog staža. Postoji statistički značajna razlika u stavovima sestara zaposlenih u Rađ/Tr te u JIL/NICU u odnosu na sestre zaposlene na mjestima rada sa OP u 22. i 23. tjednu gestacije. Postoji statistički značajna razlika u stavovima sestara zaposlenih u JIL/NICU u odnosu na sestre zaposlene na mjestima rada sa OP u 24., 25. i 26. tjednu gestacije. Nema razlike u stavovima sestara JIL/NICU-a u odnosu na sestre zaposlene u Rađ/Tr. RASPRAVA: Medicinske sestre na mjestu rada sa OP sklonije su pristupanju primarnog oživljavanja prijevremeno rođene novorođenčadi u odnosu na njihove kolegice u komparativnim skupinama. Ovakav je rezultat posljedica činjenice da sestre zaposlene u JIL/NICU i Rađ/Tr imaju drugačije iskustvo u svezi primijen terapijskih i dijagnostičkih postupaka s ciljem održavanja života novorođenčadi rođene na granici preživljenja. ZAKLJUČAK: Radno mjesto, tj. iskustvo stečno na specifičnom radnom mjestu, a ne suvremeni stavovi i preporuke kliničke bioetike, osnova su u stvaranju stavova o primarnom oživljavanju prijevremeno rođene novorođenčadi. Edukacije iz područja bioetičkih stavova mora bit trajna i u skladu sa suvremenim mjerama intezivnog liječenja i dugoročnog ishoda prijevremeno rođene novorođenčadi.AIM: The aim was to determine the attitudes of nurses in Croatia toward primary resuscitation of prematurely born infants. METHODS: A written questionnaire was distributed to the nursing staff wiith questions regarding their age, parity, work experience, work place and attitudes toward primary resuscitation of prematurely born infants. A total of 174 nurses completed the questionnaire; 49 of them working at the delivery room or in contact with pregnant women (DR/PW), 79 working at the pediatric/neonatal intensive care units (PICU/NICU), 46 working with the general population (GP). RESULTS: There were no statistically significant differences regarding age, parity and work experience among groups, nor in attitudes among DR/PW and PICU/NICU nurses There was a statistically significant difference in attitudes toward primary resuscitation of infants born at 22nd and 23rd gestational week among DR/PW – PICU /NICU and GP nurses, as well as in attitudes toward primary resuscitation of infants born at 24th to 26th gestational week among PICU /NICU and GP nurses. DISCUSSION: GP nursing staff has attitude to initiate more likely primary resuscitation of premature born infants than their colleagues in the comparative groups. Such results are consequences of the fact that PICU/NICU-DR/PW nurses have different experience towards the complexity of procedures applied in primary resuscitation of infants who are born at the margins of viability. CONCLUSIONS: Working place i.e. experience at the particular working place, but not modern guidance in clinical bioethics, play major role in creation of attitude towards the primary resuscitation of prematurely born infants among nurses. Education in clinical bioethics should be continuous, in accordance with medical advances in neonatal intensive care and long term outcome of prematurely born infants

ARREST AS A MEASURES OF ENSURING THE PRESENCE OF THE DEFENDANT IN CRIMINAL PROCEEDINGS

Rad ne sadrži sažetak

ARREST AS A MEASURES OF ENSURING THE PRESENCE OF THE DEFENDANT IN CRIMINAL PROCEEDINGS

Rad ne sadrži sažetak

Application of Wound Closure Molndal Technique after Laparoscopic Cholecystectomy – Initial Comparative Study

Because of a possible delayed wound healing, critical colonization and infection of wounds present a problem for surgeons1–3. Colonized and infected wounds are a potential source for cross-infection1–3. Molndal technique of wound dressing has proven to be effective in prevention of infection. Also the wound heal better and faster3–5. In our study we wanted to describe the benefits of the Molndal technique wound dressing after laparoscopic cholecistectomy compared to traditional wound dressing technique. Molndal technique consisted of wound dressing with Aquacel Ag – Hydrofiber (ConvaTec, Dublin, Ireland). Traditional technique was performed using gauze compresses and hypoallergic adhesives. We analyzed the results of 100 patients after laparoscopic cholecystectomy. 50 patients were treated by Molndal technique and 50 patients by the traditional technique of wound dressing. In the group trated by Molndal technique only 1 (2%) patient has revealed a wound infection, proven by positive microbiological examination and suppuration, mostly in the subumbilical incision. In the traditional technique group 7 (14%) patients developed wound infection also predominantly in the subumbilical incision. The difference was statistically significant (p<0.01). Our results are clearly showing that Molndal technique is effective in preventing the infection of subumbilical incision wound and is to by recommend for regular use at designated site after laparoscopic cholecistectomy

Prijelomi kuka u starijoj dobi - analiza kroz 10 godina

Geriatric hip fractures (GHP) are the major problem in the geriatric traumatology and it is estimated that treatment of GHF will spend a large amount of health care resources1–5. The aim of this retrospective study was to compare differences in incidence of operatively treated patients with GHF, type of treatment depending of the type of fracture, early postoperative mortality, length of stay and costs of used implants within a 10 years period. Surgically treated 2478 patients, older than 65 years with hip fractures were included in the study. Patients were grouped according to the type of fracture (femoral neck fracture or intertrochanteric femoral fracture) and used implant. Results showed increasing trend in GHF in our County in the last 10 years. There was a shifting trend in used implants, and new surgical techniques were used more commonly in the last few years. In observed period there were no significant changes in revision surgery and length of hospital stay. The mortality decreased, especially in males, but generally it was not in correlation with used implant. At the 10-years period increase in patients with GHF of 179% was followed with 4 time higher increase in implant prices. Present reimbursement in health care system does not calculate the difference of implant costs in hospital expenses, therefore proper usage of modern implants and careful planning in the treatment of GHF is necessary.Prijelomi kuka u starijoj dobi su najveći problem u gerijatrijskoj traumatologiji i može se očekivati da će se na lije čenje ovih prijeloma u budućnosti utrošiti velika količina sredstava iz zdravstvenih fondova. Cilj ove retrospektivne studije bio je usporediti razlike u: incidenciji operativno liječenih bolesnika s prijelomom kuka u starijoj dobi, načinu liječenja ovisno o tipu prijeloma, ranom poslijeoperacijskom mortalitetu, dužini trajanja hospitalizacije i cijeni korištenih implantata, u razdoblju od 10 godina. U studiju je uvršteno 2478 pacijenata, starijih od 65 godina, s prijelomom u području kuka koji su razvrstani s obzirom na tip prijeloma (prijelom u području vrata bedrene kosti ili prijelom u području trohanterne regije bedrene kosti). Retultati su pokazali porast incidencije prijeloma kod bolesnika starije dobi u našoj županiji. Prisutan je trend korištenja novijih implantata u posljednjim godinama. U analiziranom razdoblju nije uočena značajnija promjena u broju reoperacija i dužini hospitalizacije. Mortalitet je bio u opadanju, naročito u muškoj populaciji, ali ukupno gledano nije bio u korelaciji s tipom korištenog implantata. U desetogodišnjem razdoblju, porast bolesnika starije dobi s prijelomom kuka od 179% bio je praćen s 4 puta većom cijenom implantata, stoga je u liječenju prijeloma kuka kod starijih bolesnika potrebno pravilno indicirati i pažljivo planirati upotrebu modernih implantata

Prijelomi kuka u starijoj dobi - analiza kroz 10 godina

Geriatric hip fractures (GHP) are the major problem in the geriatric traumatology and it is estimated that treatment of GHF will spend a large amount of health care resources1–5. The aim of this retrospective study was to compare differences in incidence of operatively treated patients with GHF, type of treatment depending of the type of fracture, early postoperative mortality, length of stay and costs of used implants within a 10 years period. Surgically treated 2478 patients, older than 65 years with hip fractures were included in the study. Patients were grouped according to the type of fracture (femoral neck fracture or intertrochanteric femoral fracture) and used implant. Results showed increasing trend in GHF in our County in the last 10 years. There was a shifting trend in used implants, and new surgical techniques were used more commonly in the last few years. In observed period there were no significant changes in revision surgery and length of hospital stay. The mortality decreased, especially in males, but generally it was not in correlation with used implant. At the 10-years period increase in patients with GHF of 179% was followed with 4 time higher increase in implant prices. Present reimbursement in health care system does not calculate the difference of implant costs in hospital expenses, therefore proper usage of modern implants and careful planning in the treatment of GHF is necessary.Prijelomi kuka u starijoj dobi su najveći problem u gerijatrijskoj traumatologiji i može se očekivati da će se na lije čenje ovih prijeloma u budućnosti utrošiti velika količina sredstava iz zdravstvenih fondova. Cilj ove retrospektivne studije bio je usporediti razlike u: incidenciji operativno liječenih bolesnika s prijelomom kuka u starijoj dobi, načinu liječenja ovisno o tipu prijeloma, ranom poslijeoperacijskom mortalitetu, dužini trajanja hospitalizacije i cijeni korištenih implantata, u razdoblju od 10 godina. U studiju je uvršteno 2478 pacijenata, starijih od 65 godina, s prijelomom u području kuka koji su razvrstani s obzirom na tip prijeloma (prijelom u području vrata bedrene kosti ili prijelom u području trohanterne regije bedrene kosti). Retultati su pokazali porast incidencije prijeloma kod bolesnika starije dobi u našoj županiji. Prisutan je trend korištenja novijih implantata u posljednjim godinama. U analiziranom razdoblju nije uočena značajnija promjena u broju reoperacija i dužini hospitalizacije. Mortalitet je bio u opadanju, naročito u muškoj populaciji, ali ukupno gledano nije bio u korelaciji s tipom korištenog implantata. U desetogodišnjem razdoblju, porast bolesnika starije dobi s prijelomom kuka od 179% bio je praćen s 4 puta većom cijenom implantata, stoga je u liječenju prijeloma kuka kod starijih bolesnika potrebno pravilno indicirati i pažljivo planirati upotrebu modernih implantata

Stavovi medicinskih sestara u Hrvatskoj o primarnom oživljavanju prijevremeno rođene novorođenčadi

Aim: The aim was to determine the attitudes of nurses in Croatia toward primary resuscitation of prematurely born infants. Methods: A written questionnaire was distributed to the nursing staff wiith questions regarding their age, parity, work experience, work place and attitudes toward primary resuscitation of prematurely born infants. A total of 174 nurses completed the questionnaire; 49 of them working at the delivery room or in contact with pregnant women (DR/PW), 79 working at the pediatric/neonatal intensive care units (PICU/NICU), 46 working with the general population (GP). Results: There were no statistically significant differences regarding age, parity and work experience among groups, nor in attitudes among DR/PW and PICU/NICU nurses. There was a statistically significant difference in attitudes toward primary resuscitation of infants born at 22nd and 23rd gestational week among DR/PW – PICU /NICU and GP nurses, as well as in attitudes toward primary resuscitation of infants born at 24th to 26th gestational week among PICU /NICU and GP nurses. Discussion: GP nursing staff has attitude to initiate more likely primary resuscitation of premature born infants than their colleagues in the comparative groups. Such results are consequences of the fact that PICU/NICU-DR/PW nurses have different experience towards the complexity of procedures applied in primary resuscitation of infants who are born at the margins of viability. Conclusions: Working place i.e. experience at the particular working place, but not modern guidance in clinical bioethics, play major role in creation of attitude towards the primary resuscitation of prematurely born infants among nurses. Education in clinical bioethics should be continuous, in accordance with medical advances in neonatal intensive care and long term outcome of prematurely born infants.Cilj: Cilj istraživanja bio je ispitati stavove medicinskih sestara u Hrvatskoj o primarnom oživljavanju prijevremeno rođene djece. Metode: Pisanom anketom ispitivana je dob, roditeljstvo, radno iskustvo i mjesto rada te stavovi medicinskih sestara iz Hrvatske o primarnom oživljavanju prijevremeno rođene djece. Anketa je obuhvatila 174 medicinske sestre: 49 zaposlenih u rađaonici ili na mjestima rada koja uključuju rad s trudnicama (Rađ/Tr), 79 u pedijatrijskim/neonatološkim jedinicama intenzivnog liječenja (JIL/NICU), dok 46 radi s općom populacijom (OP). Rezultati: Nije bilo statistički značajne razlike među skupinama u odnosu na dob, materinstvo i duljinu radnog staža. Postoji statistički značajna razlika u stavovima o pristupanju primarnom oživljavanju novorođenčadi rođene u 22. i 23. tjednu gestacije u sestara zaposlenih u Rađ/Tr te u JIL/NICU u odnosu na sestre koje rade s OP. Postoji statistički značajna razlika u stavovima o pristupanju primarnom oživljavanju novorođenčadi rođene u 24., 25. i 26. tjednu gestacije u sestara zaposlenih u JIL/NICU u odnosu na one u sestara koje rade s OP. Nema razlike u stavovima sestara zaposlenih u JIL/NICU u odnosu na sestre zaposlene u Rađ/Tr. Rasprava: Medicinske sestre koje rade s OP sklonije su pristupanju primarnom oživljavanju prijevremeno rođene novorođenčadi u odnosu na njihove kolegice u komparativnim skupinama. Ovakav je rezultat posljedica činjenice da sestre zaposlene u JIL/NICU i Rađ/Tr imaju drugačije iskustvo u svezi s primjenom terapijskih i dijagnostičkih postupaka održavanja života novorođenčadi rođene na granici preživljenja. Zaključak: Radno mjesto, tj. iskustvo stečeno na specifičnom radnom mjestu, a ne suvremeni stavovi i preporuke kliničke bioetike, osnova su u stvaranju stavova o primarnom oživljavanju prijevremeno rođene novorođenčadi. Edukacija iz područja bioetičkih stavova mora biti trajna i u skladu sa suvremenim mjerama intenzivnog liječenja i dugoročnog ishoda prijevremeno rođene novorođenčadi