Materia socio-medica最新文献

Background: Low back pain (LBP) is a leading cause of morbidity in the healthcare profession. It is a complex problem of the biopsychosocial factors (BPS) effect, where processing mechanisms affect the experience of pain, function, participation in society and personal prosperity. Psychological factors are important predictors of poor outcomes because they can significantly influence pain management and coping.

Objective: To determine the prevalence of psychological factors, the difference in general health and the tendency toward psychological dysfunction of healthcare professionals with low back pain at different levels of healthcare system.

Methods: A cross-sectional study was conducted in five primary, secondary and tertiary level healthcare institutions in Boka Kotorska, Montenegro (December 2021 - July 2022). The study involved 192 subjects with LBP who voluntary entered the study and met the inclusion criteria. The study instrument was the General Health Questionnaire (GHQ-12), which provides information on mental health by identifying symptoms of distress. The data were analyzed using the χ2 test with a statistical significance limit of p<0.05.

Results: The study included n=67 (34.9%) respondents working at secondary level, n=63 (32.8%) at the primary level and n=62 (32.3%) working at tertiary level, predominantly female. Analysis of the psychological factors representation indicate significant differences in overcoming difficulties (p=0.05), enjoyment in daily activities (p=0.042) and feelings of happiness and progress (p=0.004). There were statistically significant differences in general health and in the tendency to psychological dysfunction (p=0.005). Tendency to somatic symptoms is most prevalent at primary (55.6%) and tertiary (51.6%) healthcare level. Respondents working at Secondary level showed a tendency towards social dysfunction, anxiety and depression (50.7%, 17.9% and 3%).

Conclusion: Psychological factors are represented differently in the healthcare profession. A statistically significant difference was found among healthcare professionals of the examined levels, especially in the feeling of inability to overcome difficulties, enjoyment in usual daily activities, and feeling of happiness and progress. There is also a significant difference in the representation of psychological dysfunction at the primary, secondary and tertiary levels of healthcare, while general health is most impaired among healthcare professionals working at the secondary level.

Background: The Out-of-hospital cardiac arrest (OHCA) remains a major public health challenge worldwide, with survival outcomes heavily influenced by early intervention. The presence of an initial shockable rhythm significantly increases the likelihood of survival when combined with timely cardiopulmonary resuscitation (CPR) and defibrillation.

Objective: To analyze patient outcomes and the incidence of bystander and dispatch-guided CPR in cases of OHCA with an initial shockable rhythm treated by physician-led emergency medical teams in Bosnia and Herzegovina.

Methods: Data for this study were collected over a 5-year period, from January 2019 to September 2023, using the Utstein protocol. Hospital records were analyzed to determine patient outcomes, with a focus on the 30-day survival rate and favorable neurological outcomes. Instances of dispatch-guided and bystander CPR were recorded for each case based on available patient records.

Results: In this study, 1,020 patients were included, with 151 cases (14.8%) having an initial shockable rhythm, of which 14.3% of males and 4.4% of females achieved return of spontaneous circulation (ROSC). ROSC rates varied by year, with the highest in 2019 (20.4%) and 2022 (17.9%). Thirty-day survival with a good neurological outcome was observed in a small percentage of cases. The initial shockable rhythm was found to be statistically significant (p<0.001) for achieving a good neurological outcome after 30 days. Dispatch-guided CPR was attempted in 12.9% of cases, with success in 1.9%. Bystander CPR was performed in 1.4% of cases, and only one case involved the use of an automated external defibrillator (AED). The median response time for successful resuscitations was 2 minutes, while for unsuccessful resuscitations, it was 6 minutes. The findings emphasize the role of age, initial rhythm, and response time in determining outcomes for OHCA patients.

Conclusion: The promising survival rate of OHCA patients, despite limited bystander CPR, highlights the impact of short response times and skilled physician-led teams, underscoring the need for public education and a unified registry to address gaps and better understand OHCA epidemiology in Bosnia and Herzegovina.

Background: Blood transfusion is when blood and blood products are given to patients during medical treatment. Nowadays, transfusion centers worldwide constantly face the same challenge: how to provide sufficient quantities of high-quality and safe preparations for each patient at the right time.

Objective: The aim of the study was to determine the number of transfused patients,the amount and type of blood products in the Polyclinic of Transfusion in the period from 01.01. to 31.12.2021.

Methods: The data about the total number of blood donations, the number of blood products produced from whole blood, and the type of blood products issued, were retrospectively used from the available database of the information system Renovation Polyclinic of transfusion, University Clinical Centre Tuzla, Bosnia and Herzegovina.

Results: The study was carried out at the University Clinical Center Tuzla in the Polyclinic for Transfusion, in the period 01.01.2021-31.12.2021., where 29672 different blood preparations were given for the transfusion treatment of 5081 patients. In the same period, 14191 voluntary blood donors came to the Polyclinic for Transfusion of the University Clinical Center Tuzla 75.4% donated blood, and 24.6% of donors did not meet the requirements for donating blood. In the investigated period out of a total of 5,081 transfused patients, 27.4% received only one type of blood product, and even 72.6% of patients were transfused with several different blood products.

Conclusion: According to our results, we can conclude that the maximum number of collected blood units is transfused, and some plasma preparations are even 86.3% more than collected, which leads us to the conclusion that it is necessary to maintain the continuity of the collection of blood supplies and to work on increasing the number of voluntary blood donors to ensure needed blood products for treatment of patients, and in the same time keep the minimum of blood reserve for extraordinary situation as was COVID-19 pandemic.

Background: Considering the highly sophisticated activities and the environment in which the work is carried out. It is extremely important to establish a well-organized and efficient team that will contribute to raising the quality of professional activity through its work, and in this way influence the greater satisfaction of patients and their families, but at the same time also reduce stress levels among health professionals. The efficiency of the work is primarily correlated with the exceptional communication of the members within the team.

Objective: The aim of the study was to analyze the perception of health professionals about teamwork in relation to professional qualification, workplace, level of health care, length of service, weekly working hours.

Methods: A quantitative cross-sectional study included health professionals from the territory of the Federation of Bosnia and Herzegovina. A sociodemographic questionnaire was used and the teamwork domain of the patient safety perception questionnaire (Safety Attitudes Questionnaire -SAQ).

Results: The survey included 791 nurses employed in the public health sector at the primary, secondary and tertiary level of health care in the Federation of Bosnia and Herzegovina who are in direct contact or interaction with patients, with at least one year of work experience.

Conclusion: Effective teams are characterized by specific knowledge, communication skills and the ability to solve problems. Good cooperation with colleagues, patients and their families, as well as all participants in the health care process, can help to accomplish the task and goal as well as possible and to achieve the desired and expected goal. The results show a positive correlation between the different examined groups, as well as great similarities in attitudes between different levels of health care.

Background: Fractures of the long bones in the lower limbs are injuries that cause severe to extremely severe pain, posing risks to the patient's circulation, respiration, and even life. Pain management for patients with lower limb long bone fractures in the emergency department is critically important.

Objective: This study aimed to evaluate the feasibility of ultrasound-guided femoral and sciatic nerve blocks in patients with lower limb long bone fractures in the emergency department (ED). The secondary objective was to assess the effectiveness of this procedure as an adjunct to pain management in the ED.

Methods: This observational study included 133 ED patients with lower limb long bone fractures who received ultrasound-guided femoral and sciatic nerve blocks (anterior approach). Feasibility was assessed by observing and recording procedural duration, number of attempts, and technical complexity. The effectiveness of pain management was evaluated using the visual analog scale (VAS) at the 5th, 10th, 15th, 30th, 60th, and 120th minutes. Data were gathered and analyzed using SPSS 25.0. Quantitative variables were described using frequencies and percentages, while qualitative variables were presented as mean ± standard deviation. Paired-samples T-tests were used to compare the pain scores at different time points.

Results: The mean age of participants was 54.21 ± 18.43 years (range 18-93), including 76 males and 57 females. The average procedural duration was 4.92 ± 1.51 minutes (range 2.4-8.5). All blocks were successful on the first attempt, with no complications. Post-procedure, pain scores decreased by 53.47% at the 5th minute, 72.73% at the 10th minute (p < 0.001), and 97.25% at 15 minutes (p < 0.001). Pain scores remained stable from 30 to 120 minutes (p < 0.001).

Conclusion: Ultrasound-guided femoral and sciatic nerve blocks (anterior approach) are feasible in the ED. This technique provides significant and sustained pain relief.

Background: The Pectus carinatum is an outward protrusion deformity of the sternum and adjacent costal cartilages. It is the second most common congenital deformity of the anterior chest wall, commonly occuring in adolescents.

Objective: The aim of this study was to evaluate thoracic morphological changes using computed tomography (CT) imaging in patients with pectus carinatum treated via the modified Abramson technique at Viet Duc University Hospital from 2020 to 2023.

Methods: A retrospective cross-sectional study analyzed all cases of congenital pectus carinatum diagnosed, imaged via CT, and surgically treated using the modified Abramson technique at Viet Duc Hospital from January 2020 to December 2023.

Results: Among 115 patients (mean age: 13.6 ± 2.03 years), the majority presented with symmetrical deformities (70.4%). The average operative duration was 33.3 ± 8.3 minutes, and hospital stays ranged from 4 to 7 days (mean: 5.2 ± 0.90 days). No major postoperative complications were reported. Follow-up ranged from 11 to 48 months. Chest CT Scan reevaluation postoperatively in 69 patients showed significant improvement in thoracic indices: mean pre- and postoperative Haller index (HI) were 2.02 ± 0.20 and 2.46 ± 0.34, respectively. Sternal rotation angle averaged 2.81 ± 3.59, with 68/69 cases showing no or mild torsion. Postoperative asymmetry index (AI) averaged -0.014 ± 0.033.

Conclusion: The modified Abramson technique provides a minimally invasive and effective treatment for pectus carinatum, achieving significant improvements in thoracic morphology as evidenced by Haller index, asymmetry index, and sternal rotation angles assessed on chest CT.

Background: As a surgical nurse in a healthcare team, it is helpful to position the patient, depending on the nature of the procedure, and to prepare independently both the instrumentation and the site of surgery with drapes prior to the surgical procedure.

Objective: To examine the experience of surgical nurses in their work with the WHO surgical checklist in Sweden.

Methods: Data were collected from one hundred and ninety-six healthcare professionals, including thirty-nine surgical nurses, using a self-administered questionnaire. The Mantel-Haenszel and Pearson χ ² tests were used for ordered and unordered categorical variables. The qualitative data was presented in the form of the positive and negative contribution of the checklist and the text was analyzed according to Graneheim and Lundman.

Results: Surgical nurses (61.6%) answered "no" to the question about being educated and trained in using checklists. Almost the same answer was given when it came to adapting the checklist to the department and the fact that the assistant nurse was responsible for ensuring the checklist was used (61.5%). 89.9% of them did not know who was responsible for implementing the checklist before surgery. According to (56.4%), the checklist was used all the time in emergencies, while (12.8%) of them stated that they did not believe that the checklist improved patient safety.

Conclusions: Compliance with the WHO's checklist varies, and the observed compliance is lower than that documented. The surgical nurses gave the same responses as others in the team. Clearer procedures are needed during surgery, specifying how the checklist should be used in practice, and there should be a designated person who is responsible for implementing the checklist.

Background: Infantile hemangiomas (IHs) are benign vascular tumors commonly observed in children. The pathogenesis of hemangiomas is complex and poorly understood. IH occur most commonly on the head and neck. There are different classification of them according to the depth, number, distribution and locations. A multidisciplinary approach is needed for the diagnosis and treatment of hemangiomas because it is easy to misdiagnose or decide on a wrong treatment in the existing single-treatment system.

Objective: In this retrospective study between 2018 and 2022 we provided an overview of the hemangiomas located in the head and neck in 232 patients, and the different treatment approaches used.

Results: Of the 232 patients 60.3 % were females and 38.7% males. The youngest age was 10 weeks old and the oldest age who underwent treatment was 79 years old. The most common lesion sites were the mid-cheek, the upper lip and the upper eyelid. 104 patients (53.4 %) underwent surgical intervention due to the location of the lesion, size and functional reasons. Meanwhile 128 patients (46.6 %) were observed and treated with propranolol and pulsed dye laser.

Conclusion: Hemangiomas are generally benign tumors. Hemangiomas present a number of diagnostic and therapeutic challenges; thus, early diagnosis by a specialist clinic is key in preventing associated morbidity with these vascular tumors.

Background: Axial spondyloarthritis (axSpA) is a potentially disabling inflammatory arthritis of the spine, usually presenting as chronic back pain typically before the age of 45 years. It is often associated with one or more articular features, including synovitis, enthesitis, and dactylitis. It may also be associated with several non-articular features; these include uveitis, psoriasis, and inflammatory bowel diseases1.

Objective: The aim of this article is to describe the status of using biological drugs and some related factors in treating ankylosing spondylitis in Vietnam.

Methods: A joint prospective and retrospective cross-sectional descriptive study was conducted on 161 ankylosing spondylitis patients treated with biological drugs at the Centre for Rheumatology between January 2018 and July 2021. Data were collected at the first dose and after 3, 6, 12, 24, and 36 months, including general characteristics, clinical and para-clinical features, drug use status, and related factors.

Results: Of the 161 patients, 86.3% were male, with a mean age of 31.1 ± 11.6 years and a mean disease duration of 7.6 ± 6.6 years. Most patients were started on biologics at stage II (46.6%) or III (28.6%). Moreover, 68.9% had active disease based on the Bath Ankylosing Spondylitis Disease Activity Index. The most commonly prescribed first-line therapy was anti-tumor necrosis factor (69.6%), with infliximab the most frequently prescribed drug (44.7%). The rate of biological drug treatment decreased gradually from 100% at the start to 77% after one year and 39.1% after three years. Moreover, 74% of patients changed drugs due to non-response, and 50% discontinued treatment for economic reasons. Age was associated with treatment adherence, and drug change rates were higher in female patients and patients with active disease. Age was significantly associated with drug discontinuation (p < 0.05).

Conclusion: Infliximab was the most commonly prescribed first-line drug. The rate of biological therapy gradually decreased after three years. Most patients changed drugs due to non-response, and many discontinued the drugs for economic reasons. Among the individual and clinical factors, age was associated with treatment adherence.

Background: Mapping exercises are important to inform development of interventions aiming to enhance private sector's contribution towards achieving health systems objectives.

Objective: To map size, types, and distribution of private health institutions, and to identify the services they offer, and their alignment with Ministry of Health priorities.

Methods: A cross-sectional study targeted licensed, for-profit private health institutions in Riyadh Region, Saudi Arabia. Secondary data were collected from Department of Private Health Institutions in Riyadh and the Ministry of Health Year Statistical Book. Descriptive statistics were employed to analyze the collected data.

Results: Private hospitals increased from 40 (2017) to 46 (2021), with private sector hospital beds rising from 5,426 (2017) to 6,339 (2021). Pharmaceutical institutions comprised 55.4% of private health institutions, followed by polyclinics (23%) and supportive health services centers (17.1%). Laboratories, hospitals, and clinics represented 2%, 1%, and 0.5% of private health institutions respectively. Ambulance and radiology service centers were least available private health institutions at 0.1%. Home healthcare, remote care, telemedicine, family medicine, and long-term care were offered by 1.3%, 0.5%, 0.4%, and 0.1% of private health institutions respectively. Private hospitals accounted for 41.4% of total hospitals and private hospitals beds constituted 30.9% of Riyadh's total, with an average of 137.8 beds per hospital. Around 82% of private health institutions were in Riyadh city, with around 18% in peripheral provinces.

Conclusion: Private healthcare sector has witnessed substantial growth, primarily influenced by supply rather than demand dynamics. Incentives are essential to promote investment in Ministry of Health priorities.