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Zoran Ridjanovic

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Summary There are four types of responsibilities that arise on the basis of medical errors: a) Disciplinary (Punishment of the competent Association for restriction or revocation of the license); b) Civil liability (compensation); c) Criminal responsibility (protection of individual interests to protect the interests of the society); d) Violation (fine for minor damage) To increase the number of criminal proceedings mostly influenced the lack of compensation system for harm because the injured party considered that after the positive completion of criminal proceedings can easily make a claim. Therefore they do not address the local Association or Ministry of Health to investigate a case, but to the criminal proceedings to try to get compensation. It turned out that this is a dispute that is usually long lasting, with an uncertain outcome, which does not bring satisfaction to the plaintiff, and had a series of negative consequences in the general approach to the treatment of patients known as “defensive medicine”. As a result of the increased number of lawsuits due to medical errors are caused the following negative consequences: a) Great vigilance of physicians in communicating with patients, who must sign a 2-3 statements when entering the hospital, and that sometimes are not really familiar with the nature of illness and required treatment; b) Significant increase in the number of unnecessary tests which are required by doctors to insure themselves from the potential liability, which at a given moment are not really necessary; c) Lack of medical error reporting system allows individuals to avoid their reporting, which affects the course of treatment and prognosis; d) Often avoidance by the doctors to perform some necessary procedures that are risky, with increasingly open refusal to cure a poor prognosis case which they left to the next level of treatment. Disappears so called “heroic approach” to the treatment in the B&H health system known from the war period and gives way to extreme caution, because the doctors expect that their every procedure will be under scrutiny; e) All of these factors create a mode known worldwide as “defensive medicine”, which increases the cost of treatment and lower level of health care; f) Reduced volume of education, because older physicians are reluctant to let residents decide on specific work procedures and operations; g) There is already a critical shortage of some medical specialties, and inevitably follows increase in price from these service areas and increase of the waiting list.

CONFLICT OF INTEREST: NONE DECLARED SUMMARY Agency for Quality and Accreditation of Federation of Bosnia and Herzegovina (AKAZ) has developed computer based chronic disease register based on the accreditation standards in order to facilitate maintenance of chronic disease registers in the absence of electronic health records, and to speed up and simplify calculation for over 70 clinical indicators from accreditation standards for family medicine teams. This article presents development of the software and its practical use.

CONFLICT OF INTEREST: NONE DECLARED SUMMARY Introduction Agency for healthcare quality and accreditation in Federation of Bosnia and Herzegovina (AKAZ) is authorized body in the field of healthcare quality and safety improvement and accreditation of healthcare institutions. Beside accreditation standards for hospitals and primary health care centers, AKAZ has also developed accreditation standards for family medicine teams. Methods Software development was primarily based on Accreditation Standards for Family Medicine Teams. Seven chapters / topics: (1. Physical factors; 2. Equipment; 3. Organization and Management; 4. Health promotion and illness prevention; 5. Clinical services; 6. Patient survey; and 7. Patient’s rights and obligations) contain 35 standards describing expected level of family medicine team’s quality. Based on accreditation standards structure and needs of different potential users, it was concluded that software backbone should be a database containing all accreditation standards, self assessment and external assessment details. In this article we will present the development of standardized software for self and external evaluation of quality of service in family medicine, as well as plans for the future development of this software package. Conclusion Electronic data gathering and storing enhances the management, access and overall use of information. During this project we came to conclusion that software for self assessment and external assessment is ideal for accreditation standards distribution, their overview by the family medicine team members, their self assessment and external assessment.

CONFLICT OF INTEREST: NONE DECLARED In order to speed up and simplify the self assessment and external assessment process, provide better overview and access to Accreditation Standards for Family Medicine Teams and better assessment documents archiving, Agency for Healthcare Quality and Accreditation in Federation of Bosnia and Herzegovina (AKAZ) has developed self assessment and externals assessment software for family medicine teams. This article presents the development of standardized software for self and external evaluation of quality of service in family medicine, as well as plans for the future development of this software package.

At the end of IX and beginning of the X century begins development and renaissance of the medicine called Arabic, and which main representatives were: Ali at-Taberi, Ahmed at-Taberi, Ar-Razi (Rhazes), Ali ibn al-Abbas al-Magusi (Haly), ibn al-Baitar, ibn al-Qasim al-Zahrawi (Abulcasis), ibn Sina (Avicenna), ibn al-Haitam (Alhazen), ibn Abi al-Ala Zuhr (Avenzor), ibn Rushd (Averroes) and ibn al-Nafis. Doctors Taberi, Magusi and Razi were born as Persians. Each of the listed great doctors of the Arab medicine in their own way made legacy to the medical science and profession, and left lasting impression in the history of medicine. Majority of them is well known in the West well and have their place in the text-books as donors of significant medical treasure, without which medicine would probably, especially the one at the Middle dark century, be pale and prosaic, insufficiently studied and misunderstood, etc. Abdullah ibn Sina (Avicenna) remained unsurpassed in the series of above listed. Close to him can only come Alauddin ibn al-Nafis, who will in mid-XII century rebut some of the theories made by Avicenna and all his predecessors, from which he collected material for his big al-Kanun fit-tibb (Cannon of medicine). Cannon will be commended for centuries and fulfilled with new knowledge. One of the numerous and perhaps the best comments-Excerpts is from Nafis-Mugaz al-Quanun, article published as a reprint in War Sarajevo under the siege during 1995 in Bosnian language, translated from Arabic by the professor Sacir Sikiric and chief physician Hamdija Karamehmedovic in 1961. Today, at least 740 years since professor from Cairo and director of the Hospital A-Mansuri in Cairo Alauddin ibn Nefis (1210-1288), in his paper about pulse described small (pulmonary) blood circulatory system and coronary circulation. At the most popular search engines very often we can find its name, especially in English language. Majority of quotes about al-Nafis are on Arabic or Turkish language, although Ibn Nafis discovery is of world wide importance. Author of this article is among rare ones who in some of the indexed magazines emphasized of that event, and on that debated also some authors from Great Britain and USA in the respectable magazine Annals of Internal medicine. Citations in majority mentioning other two "describers" or "discoverers" of pulmonary blood circulation, Miguel de Servet (1511-1553), physician and theologian, and William Harvey (1578-1657), which in his paper "An Anatomical Exercise on the Motion of the Hearth and Blood in Animals" published in 1628 described blood circulatory system. Ibn Nafis is due to its scientific work called "Second Avicenna". Some of his papers, during centuries were translated into Latin, and some published as a reprint in Arabic language. Significance of Nafis epochal discovery is the fact that it is solely based on deductive impressions, because his description of the small circulation is not occurred by in vitro observation on corps during section. It is known that he did not pay attention to the Galen theories about blood circulation. His prophecy sentence say: "If I don't know that my work will not last up to ten thousand years after me, I would not write them" Sapient sat. Searching the newest data about all three authors: Alauddin ibn Nafis (1210-1288), Michael Servetus (1511-1533) and William Harvey (1628) in the prestige Wikipedia I manage to link several most relevant facts, based on which we can in more details explain to whom from these three authors the glory and the right to call them self first describer of the pulmonary and cardiac circulation belongs. About Servetus and Harvey there is much more data than on ibn Nafis, about which on Google there are mainly references in Arabic and Turkish language, and my four references on Bosnian, with the abstracts in English. Probably the language barrier was one of the key reasons that we know so little about Nafis and so little is written, although respectable professor Fuat Sezgin from Frankfurt in 1997 published comprehensive monograph about this great physician, scientist and explorer, in which papers we can clearly recognize detailed description of the pulmonary and cardiac circulation. Also, I personally published separate monographs about this scientist, and which can be found on www. avicenapublisher.org.

This paper focuses on the importance of adaptation of evidence based clinical practice guidelines (CPG) in developing countries like Bosnia and Herzegovina in a culturally competent way. Evidence based CPG guidelines are not routinely used in Bosnia and Herzegovina. The first adapted, evidence-based guideline on the care of women requesting induced abortion was published in 2007 following a 2004 publication by the Royal College of Obstetricians and Gynecologists (RCOG) (Evidence-based Clinical Guideline Number 7, ‘The Care of Women Requesting Induced Abortion’). The first adapted clinical guideline initiated the development of a second one related to secondary prevention of cervical carcinoma. Appraisal of Guidelines for Research and Evaluation (AGREE) were used to assess the development of clinical practice guidelines with the purpose of assuring methodological quality. After receiving permission, electronic searches of medical databases were performed to identify research performed in international settings similar to ours and research that took place after the publication of the RCOG guideline. 226 articles were selected, yielding 68 recommendations related to clinical assessment questions. Using expert consensus and external reviews, recommendations were generated that provided the clinical guideline development group with an evidence base from which to make recommendations on the best possible clinical practice. Variation in values, needs, costs and resources were considered systematically in order to make a decision about which policies should be implemented locally. For the first time in B&H, the evidenced-based clinical guideline development process fostered a supportive environment for educating health care providers on evidence based methodology, and new evidence based guidelines can be initiated for potential health care providers.

In the four year period from 1985 to 1988 from 527 treated patients with diarrhoea syndrome age 0-7 years hospitalized on Clinic for infectious disease in Sarajevo, 170 patients (32.2%) had rota virus isolated as the cause isolated. Subgrouping and serotyping of rota virus are undertaken in 115 cases. Subgrouping was done well in 94.7% and serotyping in 58.2% cases. Serotype 1 of subgroup II isolated in 58.2% of to cases during four years of work, and other serotypes were isolated sporadically. For the first time in Europe, during these four years serotype 9 rota virus isolated in 17 cases. For the first time in ex Yugoslavia and Republic of Bosnia and Hercegovina, and second time in Europe serotype 8 of rota virus has been isolated in sample of feces.

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