Srpski medicinski časopis Lekarske komore

NAVIGATING UNCERTAINTY AND COMPLEXITY: UNDERSTANDING HEALTHCARE PROFESSIONALS IN ADDRESSING PATIENT SAFETY CHALLENGES

2024-04-02T17:44:07+02:00

Providing optimal quality care is a challenge for professionals and healthcare systems around the world. Patients often rely on healthcare providers to assist them with their health concerns and to provide the safest and best possible care. However, despite the best efforts of healthcare providers to deliver high-quality care, unexpected adverse events can affect a patient. These events can be difficult for both patients and healthcare providers to deal with, particularly when they result in severe harm to the patient.

In addition to the physical and psychological toll that these adverse events can take on patients, healthcare providers can also be emotionally affected. Healthcare providers who are involved in adverse events are often referred to as second victims. These professionals are not only directly affected by the adverse events experienced by the patient but also by the response that these events can provoke in other healthcare team members, directives, and within the health institution.

Adverse events often have a systemic cause, meaning they can result from a combination of organizational, cultural, and environmental factors.

Although usually the professional in charge of patient care who is directly related to the harm is singled out as responsible, there is a chain of events and professionals involved in most events. As a result, other healthcare team members may also be involved in the event, either directly or indirectly. This can create a sense of shared responsibility among the team and a shared sense of loss or guilt when adverse events occur.

Healthcare providers and organizations need to recognize the impact of adverse events on patients and providers. By providing support and resources to second victims, healthcare organizations can help mitigate the emotional toll of these events and support providers in continuing to provide high-quality care to their patients.

This paper outlines key elements for a better understanding of the second victim phenomenon and just culture principles, in accordance with the ERNST Consortium insights.

ADVANTAGES AND DISADVANTAGES OF THE INTEGRATION TO THE EUROPEAN UNION: THE SURVEY AMONG MEDICAL FRESHMEN IN SERBIA

2024-04-02T17:44:07+02:00

Aim: The study aimed to identify factors associated with pro-integration attitudes to the European Union (EU) among Serbian medical freshmen to promote integration.

Methods: In the period from 2010 to 2021, within the scope of the distance learning module "Medicine & Society", a total of 1333 freshmen of the Faculty of Medicine of the University of Belgrade (1333/1940, i.e., response rate 68.7%) has responded to the semi-structured questionnaire inquiring their perception of the EU integration advantages and disadvantages.

The association of the pro-EU attitude (vs cons-EU / undecided) with perceived advantages and disadvantages was presented using the odds ratio (OR) and 95% confidence interval (CI).

Results: A total of 48.5% of respondents were pro-EU integration, 42.7% were undecided and 8.9% were cons-EU (i.e., 585, 525, and 107, respectively) integration of Serbia. The pro-EU attitude was 55% more likely among male respondents (OR: 1.55, 95% CI:1.14-2.10), among respondents who were able to identify advantages of EU integration such as easier mobility (OR: 2.87, 95% CI: 1.80-4.57), variety of job opportunities (OR: 2.06, 95% CI: 1.45-2.93), and among those for whom competition at the EU healthcare market is not a disadvantage of the EU-integration (OR: 8.56, 95% CI: 1.79-40.92). The pro-EU attitude was less likely among respondents who identified high emigration of medical doctors as a disadvantage of the EU integration, by 45% (OR: 0.55, 95% CI: 0.36-0.84).

Conclusion: During the last decade, the share of Serbian medical freshmen with pro-EU and undecided attitudes suggests the need for a stronger international initiative of EU and national actors. Advantages such as easier mobility, competition in the EU healthcare market, and a variety of employment opportunities promote an integrationist attitude, in contrast to the large emigration of medical doctors.

UTILIZATION OF BABY-FRIENDLY SERVICES IN MATERNITY WARDS IN SERBIA

2024-04-02T17:44:08+02:00

Introduction/aim: Breastfeeding, as a topic for health promotion and research, continues to be relevant due to numerous benefits for both the child (decreased mortality, strengthening of immunity, reduction of allergies, respiratory and digestive disorders, obesity and diabetes, increased IQ) and the mother (reduced risk of hypertension, diabetes, hyperlipidemia, cardiovascular diseases, breast and ovarian cancer). The study aims to propose effective and efficient health promotion activities directed towards increasing the percentage of exclusively breastfed newborns and infants up to six months of age, in Serbia.

Method: The study was conducted as a secondary analysis of data obtained in Multiple Indicator Cluster Survey 6 (MICS 6) for the national and the Roma ethnic group sample, in Serbia, in 2019. The association between the utilization of the following services: skin-to-skin contact, early breastfeeding, and full-time rooming-in for mother and baby, and the socio-demographic variables of mothers, were examined using univariate and multivariate logistic regression analysis. Statistical significance was determined at p < 0.05 (Student t-test, Pearson's chi-square test, and Mann-Whitney U-test).

Results: The examined socio-economic characteristics of the mothers in both samples were not associated with the use of baby-friendly services. A significant statistical difference exists in relation to the type of delivery in both samples. Women who gave birth by caesarean section remain deprived of utilizing the procedures that have proven positive short-term and long-term effects on the health of both the child and mother. In both samples, there was a significant increase in rooming-in in the Belgrade region, where the maternity hospital leading the National Breastfeeding Support Program is located.

Conclusion: The most effective measures to improve breastfeeding are related to the adoption of breastfeeding support policies in health facilities and the obligation to train the entire staff who are in contact with mothers during their stay at the maternity hospital (20-hour WHO breastfeeding counseling training).

DETERMINANTS OF THE HUMAN PAPILLOMAVIRUS (HPV) VACCINATION INTENTION AMONG STUDENTS

2024-04-02T17:44:08+02:00

Introduction: Human papillomavirus (HPV) is the virus that is most often associated with cancers. Cervical cancer is one of the leading public health problems, especially in developing countries. In the Republic of Serbia, cervical cancer is the fifth most common cancer in the female population amongst all malignant diseases, and HPV infection is the most important risk factor for the occurrence of this disease. This study aims to identify the determinants of adolescent HPV vaccination intention.

Materials and methods: The study was conducted as a cross-sectional study including a total of 748 students, aged 12 – 19 years, from one high school and two elementary schools in Šabac. The research instrument was a questionnaire, particularly constructed for this study. Multiple regression analysis was applied to examine the predictive model for explaining the HPV vaccination intention in young people.

Results: The proposed model explains 66% of HPV vaccination intention in young people. The strongest predictor of HPV vaccination intention in young people relates to the subjective norm, i.e., social pressure from peers and other people who are important to them. Distrust of the benefit of vaccination, concern about commercial profiteering, and belief in a "vaccine conspiracy" have a significantly smaller but statistically significant contribution in explaining HPV vaccination intention amongst our youth.

Conclusion: Increasing social pressure to get vaccinated, as well as changing certain attitudes and beliefs about vaccines in general, may lead to an increase in the intention of young people to get vaccinated against HPV. Understanding the key aspects of the attitudes of young people in Serbia towards HPV vaccination opens the possibility of creating evidence-based public health policies and planning targeted health-educational interventions directed at the identified findings.

SEPTIC STATE IN THE DIFFERENTIAL DIAGNOSIS OF FEVER OF UNKNOWN ORIGIN

2024-04-02T17:44:08+02:00

Introduction: In the modern world, fever of unknown origin is becoming an increasingly common entity with varied etiologies. Septic condition has a significant role as an etiological factor of fever of unknown origin, often being overlooked or treated late.

Objective: To determine the frequency of sepsis, to establish demographic characteristics, clinical presentation of the disease, to identify the proportion of proven pathogens and their distribution by type, and to present laboratory analyses of patients diagnosed with sepsis upon admission and discharge from the hospital.

Materials and Methods: The study included patients treated at the Clinic for Infectious and Tropical Diseases of the Clinical Center of Serbia, in the Department of Clinical Pharmacotherapy, from December 1, 2014, to December 31, 2017, with documented sepsis during the investigation of the etiology of FUO.

Results: Among 420 patients studied, sepsis was documented in 50 (11.9%). The study included 29 (58%) women and 21 (42%) men, with an average age of 63.76 ± 13.6 (24-90) years. The causative agent of the disease was detected in blood cultures in 40 (80%) patients, while not in 10 (20%). Elevated body temperature occurred in 49 (98%) patients, whilst 24 (47%) experienced chills and shivering, 13 (25.5%) nausea, and 16 (31.4%) vomiting. Headache occurred in 8 (16%) patients, while diarrhea, urinary symptoms, and altered consciousness were observed in 11 (21.6%) patients. By comparing the median values of biochemical analyses of patients obtained upon admission and discharge from the hospital, a statistically significant difference (p<0.01) was found, indicating a decrease in laboratory parameter values such as erythrocyte sedimentation rate, C-reactive protein, total leukocyte count, and percentage of segmented leukocytes.

Conclusion: In the observed sample, sepsis occurs relatively frequently (11.9%) as an etiological factor of FUO. In the differential diagnosis of fever of unknown origin, despite significant progress and development of sophisticated diagnostic procedures, one should always consider potential systemic infection as a possible cause, among which septic condition occupies an important place, even when initial examinations do not lead to such a conclusion.

CAUSE OF PREMATURE BIRTH AS A PROGNOSTIC FACTOR OF NEONATAL OUTCOME AND TYPE OF DELIVERY

2024-04-02T17:44:08+02:00

Introduction: Premature birth, occurring before the 37th gestational week, is commonly attributed to uterine contractions, premature rupture of the amniotic sac, or placental abruption. In 20% – 30% cases involving maternal or fetal complications, premature birth may be induced, often due to conditions such as preeclampsia, fetal growth retardation, or severe maternal heart disease.

Aim: The study aims to determine whether the cause and time of preterm birth affect the neonatal outcome.

Material and methods: This retrospective study analyzes patients prematurely born at the Obstetrics and Gynecology Clinic Narodni Front in 2020, the cause of their premature birth, as well as the status of the fetus after birth. In the study, we compared the neonatal outcome in spontaneously induced preterm birth.

Results: Among all the births (n = 4,211), in the period between July and December 2020, there were 498 preterm births, i.e., 11.83%. Based on the data on the status of the premature infants' vital signs, the percentage of stillborn preterm infants was 8.9% while the percentage of live births was 91.1%. The Apgar score was the highest in neonates born by vaginal birth after the 34th week of gestation, with intact fetal membranes and spontaneous contractions. According to the study, 54.1% of preterm births ended in cesarean section due to gestational age younger than 28 weeks and with a predominantly pelvic presentation of the fetus.

Conclusion: The high rate of premature births highlights a serious problem and suggests a continued rising trend, despite preventive efforts. Improved outcomes are seen in pregnancies reaching later gestational weeks, particularly after the 34th week of gestation, with intact fetal membranes and no signs of infection. Spontaneously born premature infants tend to have higher Apgar scores and better neonatal outcomes, as compared to induced births.

DIETARY HABITS OF NIGHT SHIFT WORKERS – A REASON OR AN EXCUSE FOR POOR NUTRITION

2024-04-02T17:44:09+02:00

The availability of artificial light and light-emitting devices has changed human life in relation to time, enabling 24-hour health care, trade, and production, as well as the expansion of social life around the clock. In Europe, about 21% of the labor force consists of shift workers. 10% of the employed population work evening shifts or the night shift, and 7% of employees in Europe regularly work the night shift. According to the Bureau of Labor Statistics, more than 15 million Americans work the night shift. Shift work, especially night-time work, seriously affects dietary habits.

It is known that night-time work produces a conflict between the socially determined rhythm of eating and the circadian biological rhythms related to the feeling of hunger, satiety, as well as the metabolism itself. Night meals cause disorders of intestinal motility, affect digestion, absorption, but also the utilization of nutrients and possible medical therapy (if the individual has one). From the point of view of chronobiology, humans belong to diurnal species, which to a certain extent explains why night shift workers have a decreased appetite at night, when the human body is programmed for rest and fasting, as well as for endogenous mobilization of glucose. From the psychosocial aspect, shift workers usually experience a discrepancy between their daily routines (including the meal schedule) and those they have with family and friends, which further leads to even more severe disorders of dietary habits.

However, it is difficult to give dietary recommendations regarding nutrition. Firstly, there are no clear views on whether night shift workers should eat during the night hours or not. Secondly, even if night eating is encouraged, definitive evidence is lacking on which types of food should be consumed and which should be avoided. Thirdly, the most nutritious foods may not be available at that time of night. Finally, eating at night certainly has an impact on the metabolism. With all the above in mind, we have tried to provide some useful guidelines regarding these issues.

PERIOPERATIVE MANAGEMENT OF HIGH-RISK CARDIOVASCULAR PATIENTS IN ABDOMINAL SURGERY

2024-04-03T10:59:03+02:00

Introduction: The preparation of cardiovascular patients for different types of surgical interventions represents a challenge in an anesthesiologist’s everyday practice. Its complexity depends on the severity of the underlying disease, the effects of the drug treatment, urgency, and the type of surgical intervention. Different types of scoring systems are available when it comes to the assessment of cardiovascular risk in patients during surgery. One of them, Revised Cardiac Risk Index (RCRI/Lee criteria), stands out due to its comprehensiveness and simplicity, and is thus applied most frequently. Using the example of two patients with cardiovascular disease, the aim of this paper is to show how the risk of perioperative complications can be reduced by applying a multidisciplinary approach, along with an individualized strategy and modern guidelines.

Case reports: In the first case, we presented a patient with acute appendicitis. Because of angina pectoris, one month prior to the planned abdominal surgery, Percutaneous Coronary Intervention was performed placing one stent, after which dual antiplatelet drugs were prescribed.

A patient with acute cholecystitis is presented in the second case. Coronary artery bypass grafting is planned within a month upon the abdominal surgery, due to a severe form of ischemic cardiomyopathy. Both patients are at high risk of myocardial damage during surgery, the first patient being at high risk of hemorrhage as well.

Conclusion: The appropriate balance in the perioperative care of such patients can be achieved by a multidisciplinary approach, as well as by adapting modern guidelines to patients’ individual needs.

PEDICLED TRAPEZIUS MUSCULOCUTANEOUS FLAP IN THE RECONSTRUCTION OF A SHOULDER DEFECT AFTER THE RESECTION OF SOFT TISSUE SARCOMA – CASE REPORT AND LITERATURE REVIEW

2024-04-02T17:44:09+02:00

Introduction: Soft tissue sarcomas (STS) in the extremities require complex treatment involving limb-sparing surgery with adjuvant therapy. The treatment involves tumor resection with wide margins along with additional radiation and/or chemotherapy. In addition to tumor resection, an important aspect is the reconstruction of the resulting soft tissue defect. For extensive reconstructive procedures in the upper extremities, literature suggests the use of free or pedicled flaps. In the shoulder region, due to its complex regional anatomy, selecting an appropriate flap is the surgical imperative. Recently, there has been significant interest in the use of the pedicled trapezius musculocutaneous flap, which offers certain advantages over other flaps.

Case report: A female patient (31 years old) with STS in the left shoulder region, was surgically treated three times. The first surgery involved an intralesional procedure – R2 resection when a pleomorphic dermal sarcoma was diagnosed. After five months, a recurrence of the disease was detected based on magnetic resonance imaging (MRI) findings at the site of the surgical scar. Tumor resection was performed, and the soft tissue defect was covered with a free Thiersch partial-thickness skin graft. Histopathological analysis revealed a high-grade leiomyosarcoma. Two months after the second surgery, MRI findings confirmed a recurrence of the disease. Wide tumor resection was conducted, and the soft tissue defect was covered with a pedicled lower trapezius musculocutaneous flap.

Conclusion: The literature lacks studies describing the outcomes of the use of trapezius flaps in the reconstruction of defects in the shoulder region following STS resection. Additionally, there is no unanimous official opinion on the resection margin width that is considered safe. The treatment outcome of our patient indicates the significant potential and advantages of the trapezius flap, as compared to other flaps of that region.

ANAPHYLACTIC SHOCK CAUSED BY SUBCUTANEOUS IMMUNOTHERAPY WITH THE ALLERGEN AMBROSIA ELATIOR – CASE REPORT

2024-04-02T17:44:09+02:00

Introduction: Sensitization to ragweed pollen can lead to symptoms of allergic rhinitis, conjunctivitis, and allergic asthma. Allergen immunotherapy (AIT) is an immunomodulatory therapeutic procedure that, in addition to short-term curative effect (reduction of disease symptoms), also has a long-term preventive effect (preventing the progression of allergic rhinitis into allergic asthma and/or preventing the development of a more severe form of the disease). The two main AIT administration modalities used in clinical practice are subcutaneous allergen immunotherapy (SCIT) and sublingual allergen immunotherapy (SLIT). Both modalities are equally effective in reducing disease symptoms, but the use of SCIT is associated with a higher risk of local and systemic adverse reactions.

Case report: A patient who developed a clinical picture of anaphylactic shock during the induction phase of SCIT with Ambrosia elatior pollen extract is presented in this article. The clinical course is described as well as the quick and effective therapeutic management of this life-threatening condition.

Conclusion: When properly dosed, in a medical facility and under medical supervision, SCIT with Ambrosia elatior is a very safe and well-tolerated treatment option for allergic rhinitis. Local reactions at the site of subcutaneous administration occur more often than systemic adverse reactions. Anaphylactic shock is the most severe form of a systemic allergic reaction that affects multiple organ systems and can end in death, usually due to airway obstruction and cardiovascular collapse. It is necessary to educate the medical staff as well as the patients regarding the proper treatment of this difficult condition. Based on the assessment of risk factors in each patient, severe reactions to SCIT can be predicted and avoided with appropriate precautions and prophylactic measures. Future innovations in AIT are expected to further improve the efficacy and safety of this form of treatment for allergic diseases.