Summary Introduction: XXII European Congress of Medical Informatics (MIe 2009) took place in Sarajevo from August 30th to September 2nd 2009. Assessment of quality of papers presented at MIe 2009 was a process of observation, measurement, comparison and evaluation of the quality of orally presented papers. Methodology: For this study, and for the first time since EFMI founding (1976) and MIE congresses, the authors introduced a specially created quality assessment form with five relevant paper quality variables (methodological approach, international influence, scientific content, language quality, technical features) which the first author of this article used in peer-review process of papers submitted for publication in the journal Acta Informatica Medica (as Editor-in-Chief for last 18 years). The survey was conducted on the principle of random sampling of participants of MIE 2009 Conference in Sarajevo, where specially trained interviewers (final year students of medicine and engineering at the University of Sarajevo) interviewed 33 session’s chairs and 110 participants/listeners of MIE 2009 paper presentations in 33 sessions (of total 40). Data was collected, entered into a specially created database, analyzed and presented. Results: From the total of 150 oral presentations at the MIE 2009, 110 oral presentations were graded by both chairs and participants/ listeners. Grading results were compared and we found that in 60% of cases (66 papers) session chairs gave higher ratings than other participants of the congress. The highest rating was 10, and the lowest 3. Only 3 of the papers received all four grades 10 from the session chairs. The most common grade given by chairs of the session was 8 (26.36%), followed by 7 (20%), 9 (19.32%), 6 (13.18%), 10 and 5 (7.50%), 4 (5%) and 3 (1.14%). Significant differences in quality assessment of papers done by chairs and those done by other participants/listeners are observed. Conclusion: This work should demonstrate the importance of introducing universal (uniform) scale for assessment of articles at conferences that would provide objective and relevant assessment, which has not been the practice. Results obtained using a single standardized scale can be compared to each other and thus improve the quality of the articles and the congress. Future congresses can be organized in this manner and become leading events in certain fields of medical science.

In Mostar, at the Hotel Ero, on December 4th 2009 by the Medical Chamber of Herzegovina - Neretva Canton, was organized the symposium on “Medicine and Media.” At the symposium was presented 13 papers divided into two sessions. Papers were multidisciplinary in character and exhibitors were from several faculties of the University in Bosnia and Herzegovina. This is the first time in Bosnia and Herzegovina that on one place meet and exchange their opinions teachers, researchers and professionals of several disciplines that deal with topics from medicine and the media - two important areas in the life of every man, which are in daily contact and mutual dependence.

Summary Medicine and the media are two areas important in the life of every man, which are in almost daily contact with each other and in dependence. Their relations in BiH are currently elemental, focused on direct, immediate needs, without defined rules, with a lot of disorientation, incompetence and irresponsibility, often without respect for at least the minimum rules of conduct and respect, often with a lot of conflict and hostility. The goal of our work is based on the analysis of newspaper articles, TV programs and Web sites in the period of one year and was to assess the current situation and suggest solutions. In order to acquire objective insight into the current situation, in the preparation of the symposium “Medicine and Media” in Mostar, we analyzed all stories related to medicine in two daily newspapers, two weekly, three TV stations in the period from September 1st 2008 to August 31st 2009, and the web sites of hospital institutions, Department of Health Insurance in Bosnia and Herzegovina and the Ministries of Health which were available online on 1st and 2nd September 2009. In total we managed to process 402 contents as written content, TV shows or stories in TV shows and 28 web pages, and we believe that our sample is representative. We have found the following characteristics of the current situation in BiH that have to be changed: Topics in the press, web sites or programs on health services should have some kind of certification, i.e. licensing so that is clear that the contents of the announcement is made under control of health care professionals, i.e., licensed or of optional entertainment content; In cases of professional accusation of any specific person, usually a doctor, not to state full name of the before the existence of binding court decisions, or in case of possible litigation not to allow favoring of any party of the dispute; In addition to the interest in the work of health institutions it is necessary to direct media attention towards the work of the Institute and the ministries of health insurance, because very few reports deal with their work and activities; It is necessary to emphasize investigative reporting with good topics covered by professionals and annual prizes awarded to the authors of such content about medicine in BiH should be considered.

Summary Computer technology is a reality of our modern world. It gives us a tool which can be used to help us cope with the complexity and efficiency which is often required in many areas of work. It is an erroneous assumption that it robs a situation of its human qualities. No one would deny that the use of a word processor denies the possibility of highly creative writing being produced or that computerized checkouts make the interaction skills of the checkout person irrelevant to the process of struggling with the week’s shopping once more. In many ways, the use of the computer frees the person from the drudgery of repetitive labour to allow more time and effort to be available for the more personal skills to find expression. Recording assessment data using a computer keyboard allows just as much caring communication between nurse and clients as writing it down on a form. The critical factor is not the method of recording but the interpersonal skills and motivation of the nurse. The nursing profession is at last beginning to appreciate the role which the new technology can have in improving the service provided to patients. Only by taking an active role now in the implementation of computers to clinical practice can nurses maintain control of their own professional contribution to the large complex systems at present being implemented in many health care settings. Knowledge based systems are set to become a major component in the nurse’s ability to take on this role.

Summary Introduction: Affective disorders were known even in ancient times. Today is the official name of the ICD-10 bipolar affective disorder (F31) and represent sub category of mood disorders (affective disorders) with code F30-F39. Goal: The aim of this study was to examine and display the frequency of bipolar disorders in the total number of patients at the Psychiatric Clinic in the period 2006-2008, in order to examine the demographic profile of patients and to determine the length of hospitalization. One of the goals is also to show the number of patients with bipolar disorder compared to all other patients in the group F30-39, with respect to the research period. Patients and methods: During the research is used a retrospective-prospective study of clinical-epidemiological character. The study included all 3713 patients with different diagnoses, which were hospitalized at the Psychiatric Clinic of the Clinical Center in Sarajevo in the period from January 1st 2006 to December 31st 2008. From the total number of 3713 respondents selected are those with bipolar affective disorder, 63 (1.7%). The diagnosis was set according to ICD-10 Classification (F30-39). Results: Of the total number of patients 3713, there were 63 (1.7%) subjects with BD. From this number in 2006 was 21 (1.6%); in 2007–20 (1.7%), and in 2008–22 (1.7%) Patients with F31.1 was present in 2006 year as 5 (23.9%) cases and in 2007 the dominant group consists of respondents with F31.2–8 (40%), while in 2008 patients with F31.2 had 7 cases (31, 8%). The average duration of hospitalization in 2006 amounted to 43.7 days in 2007 to 40.9 and in 2008 to 37 days. Conclusion: Bipolar disorder is often incorrectly diagnosed as is also possible in this study given the small percentage of the disorder in relation to the total number of patients. Bipolar disorder has a direct impact on the quality of life of patients. Because of these facts, timely diagnosis and appropriate treatment are very important, and as a result, their suicide prevention.

With Ibn Sina great Canon came the "golden age of Arabic medicine", almost to its peak. Since the beginning of XI century, when Ibn Sina died, until the middle of XIII century, when creative was Ibn al-Nafis, medical science continues to develop and progress, and had its brilliant minds. For that time characteristic is the fact that neither the strong authority as Avicenna was could paralyze the progress of medical science. Three hundred years before Paracelsus, in Cairo appears a medical scientist who dares to touch the authority of Ibn Sina-Avicenna in the infallibility of Canon-"Medical Bible". The scholar was called Alauddin Ibn al-Nafis (1210-1288). He, 250 years ago Servet, (Michael Servetus, XVI century) reveals the truly describes the small or pulmonary circulation, but also gives a description of the great forerunner of the bloodstream. In his separate work on the anatomy, Ibn al-Nafis in five places contested arguments of Galen's teachings, which also Ibn Sina was accepted. He very persuasively argues that the blood does not oxidize ("does not mix with air "), passing through some hypothetical pores in the partition between the right half of the heart, in which blood is collected and left half, in which, supposedly is the air, but that this happen when the blood is going from the right ventricle through the pulmonary artery into the lungs, where it is mixed with air and thus "converted" murmurs through the pulmonary vein into the left half of the heart. On occasion of the 800th anniversary of Ibn al-Nafis birth, one of the largest Arab and world doctors of all times we publish this article so that readers get something closer image his creative work, especially the one which relates to his contribution to the discovery of cardiac and pulmonary circulation, revolutionary discoveries in the world of medicine. In the year 1924 a heated debate started regarding the discovery of the pulmonary circulation. This discovery was attributed only to European scholars. It stemmed back to the sixteenth century. When Michael Servetus (1511-1553), Anderea Vesalius (?1514-1654), Nicolai Massa (1485-1569), Realdo Colombo (1520-1654), Valverde De Hamusco (1508-1565), Andera Cesalpino (1519-1603), Fabrici d'Aquapendent (1533-1619) and William Harvey (1578-1657) developed the concept. However, Muhyi-d-din At-Tatawi (1896-1945) presented his thesis "Der Lungenkreislauf nach El-Korachi. Dissert, z.eil. d. Doktorwrde, Freiburg im Brisgau 1924" of the blood circulation according to al Qurashi relaying on his discovery of his description of pulmonary circulation in one of ancient manuscripts, He proposed that the real credit for the discovery of the pulmonary circulation belongs this eminent physician of the thirteenth century: Ibn al-Nafis. Later another doctor Abdul Kareem Chihade (1922- ) presented another dissertation in Paris 1951 entitled" decouverte de la circulatio pulmonaire chez Ibn an-Nafis". Published by Institut Francais De Damas 1955. Other prominent professors like: Paul Galiounji and Salman Qatayyah researched extensively in his manuscripts and produced very important monographs. The general consensus is that Ibn al-Nafis' work exerted great influence on the development of medical science, both in the Islamic world and Europe. A closer look on Ibn al-Nafis contribution would indicate that he also described the coronary circulation, the cranial nerves the gall bladder anatomy and many new aspect of ophthalmology. He advocated as well therapy through nutrition. His work integrated the medical knowledge with great clarity and emphasized precision.

GOAL To evaluate risk factors of erective dysfunction (ED) and find out incidence in patients with newly diagnosed diabetes mellitus. MATERIAL AND METHODS All patients from Centre for Diabetes with newly diagnosed diabetes mellitus type 2 are involved in study. We have done interview using questionnaire-International Index of Erectile Function (IIEF)-5. Result of IIEF-5 less than 21 was used as bottom line for identification of patients with ED. RESULTS Newly diagnosed diabetes mellitus type 2 was a case in 243 patients from which 37% of them had ED. Comparing potent man with those with ED there are statistically significant difference according to smoking, duration of smoking, hypertension, body mass index and serum level of glycozated hemoglobin HbA1c. Using multivariate logistic regression model, age was identified as the most significant risk factor. CONCLUSION Patients with newly diagnosed diabetes mellitus have high prevalence of ED which can be related with other risk factors such as age of diabetes onset, hypertension, smoking and body mass index.

Cardiovascular diseases are still the major cause of death, morbidity, mortality and loss of quality of life in European countries and worldwide. In Bosnia and Herzegovina we have burden of cardiovascular diseases with higher rate of morbidity and mortality than in the countries of EU zone or broader Europe. The cause of mortality is in close relation to multiple risk factors but also with specific conditions in our country; post war situation, transition and overall economic position. The main mission of European Society of Cardiology is to improve quality of life in the European population by reducing the impact of cardiovascular diseases. HeartScore web based program and PS Standalone program are introduce to assesses the overall risk of cardiovascular death for a period of 10 years, based on variables such as age, sex, smoking, systolic blood pressure and cholesterol levels in the blood, or total cholesterol/HDL ratio. Standalone PS HeartScore is practical to use, requires no permanent internet connection, the system offers its own database for each patient and the print version of the guidelines to reduce risk factors, based on evidence based medicine Program is tailored to patients, the system provides a graphical representation of the absolute risk of CVD, a version for our country is developed on the principle of high-risk populations and is available in the languages of the peoples of Bosnia and Herzegovina. Program is available for all types of medical practice which is equipped with computers, the laptop, and suitable for community nursing service as well.

Summary Family medicine physicians in their daily practice meet with a number of diseases and conditions that are the result of stress and physical trauma. One of the most frequent is post-traumatic stress disorder syndrome, which in our terms is a result of the aggression on Bosnia and Herzegovina and in total morbidity occupies more than 30% of all mental illnesses. This paper describes one such case in our practice. Timely diagnosis means the establishment of adequate therapy and relatively successful treatment.

Summary On World Press Freedom Day (3rd of May 2009) details of the Frida Haus ranking list of press freedom in countries around the world were officially disclosed. Bosnia and Herzegovina is ranked at 98 place, and in the region better ranked is only Montenegro, which is located between 78 and 80 place along with Botswana and Eastern Timor. Top rated is Iceland with 9 points and on the last place is North Korea, with 98 points. Almost every profession has its deontology/ethical principles. However, medicine and the media are specifically targeted by public controversy with regard to the consequences of their responsibilities for the individual and the overall population. Until twenty years ago, the media were the main social system or a reflection of the social system and dominated the field of public communication, which implicitly reflected in the organization, operation and effects of companies, corporations, etc. as the overall social system, increasing the gross national product and its various categories enabled boom. Medicine and health represent to a wide range of people, perhaps, the most interesting source of information, and probably there isn’t a person that once was not interested in quality professional and verified information regarding some of their medical condition or overall health status. It is estimated that today there are more than a million Web sites on health and diseases, which means that the availability of health information for users is better today than ever before. However, it is important to patients and users of web sites with health information to learn how to properly use them, and learn to assess whether the information published on this site are of reliable quality, which depends on the authors who put the information on the web site, their topicality, simplicity in use and especially the diversity of the medical content of these web pages. It is the Internet that allows the revolution in relation patient-health care- health services provider. First look is at the symptoms and other health information on the Internet before patients actually go to the doctor. In response to this there is change in the relation patient- doctor, there are attempts to allow the patient to make a test, for example, cholesterol in the blood prior to scheduling the examination by the doctor. The vision of the future is Web-based and secure health record (Medical Record) that can be maintained in some kind of health plan or supervised by a physician. Such a site can be used when the patient is traveling or when he or she goes to the pharmacy or doctor of any specialty. Access to appropriate information may strengthen patients to express their demands and medical professionalism in order to improve clinical decision making. Information on support of patients and their involvement in prevention, alternative treatments and their care should be a central part of quality improvement strategies. Improving the quality of information and helping people use the most of what is offered have to be realized by implementing the strategies. Governments should invest in public education programs to encourage people to critically evaluate health information. For their share, they will have to be aware of the scope and quality of information sources that can be used by patients, so that they can get advice from them in an appropriate manner.

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.

Summary Public health is a broad field that touches several different medical disciplines such as epidemiology, public health informatics, health statistics, environmental protection (ecology), sociology, health promotion, disease prevention and organization of health care for nosological groups of the population. In Europe and the world today is developed a fairly extensive network of scientific and professional institutions engaged in research projects, studies, organization of scientific conferences and publishing scientific and professional articles from the field of public health. Their goal is to promote scientific advances in the field of public health through the exchange of experiences of public-health professionals, training, demonstration of appropriate research models, simulation and application in medical practice.

The slamic authors of the medical and other works have become very known for West, but under well changed names, as for example Razes for Ar-Razi, Avicenna for Ibn Sina, Alhazen for Ibn Haitham, Avenzoar for Ibn Zuhr, Avveroes for Ibn Rusd etc. Up to those changes in the names has not come at any case come accidentally. This was the result of the religious striving to the cultural worls of the West, and not to speak about the plebs, only the giants are represented wich was imppossible to avoid. It is indusputable the great contribution of the Islamic authors to the development of the biomedical sciences. They not only succeeded to preserve the achievements of the pre Islamic authors, than they by the own researches gave the great contribution to the development of these sciences and their disciplines, and they have overgiven to us as a dowry.

Summary Introduction: In recent decades, the development and improvement of technology is rapidly advancing. The development of science, new materials, information technology, new procedures and other modern achievements were his first confirmation sought to improve living conditions, particularly in achieving better health conditions. In an effort to improve living conditions, solve the problem of severe diseases and to facilitate treatment, new technologies, almost always find its first application in medicine. In such conditions of general pressure of new modern technologies, health professionals often succumb to uncritically use these technologies. Methodology: Analyzing data collected from 30,000 research papers that have done 30 doctors of family medicine and 30 doctors of general medicine, and from interviews conducted with all 60 doctors who participated in the research. Results: a) Teams of family medicine have a significantly higher professional education, and it should be noted that there was no significant difference in length of service of employees; b) Teams of family medicine have significantly less committed population on which the care; c) Teams of family medicine in an average have fewer visits per day than the teams in general medicine; d) Information diagnostic technologies are more accessible to family medicine teams. Conclusion: It is necessary to introduce a technology assessment as a standard scientific methods in decision making and the creation of the health system. In fact, it is necessary to establish and enable institutions to assess health technologies and join the developed world in creating better health care.

AIM To assess efficacy of surgical and medical (conservative) treatment of acute exacerbation of chronic extremity ischemia by evaluating their early therapeutic outcomes in terms of mortality, extremity amputation and reamputation rate, limb salvage rate and length of hospitalization period. PATIENTS AND METHODS Patients were divided into two groups based on method used for the treatment of critical ischemia. Group A consisted of 40 patients that were subjected to surgical treatment of critical extremity ischemia during period 2004-2009. All patients were subjected to thrombectomy in local anesthesia (2% lidocaine) as initial step of treatment protocol. Urgent Seldinger angiography was performed for all patients that have undergone thrombectomy regardless of successfulness of thrombectomy. Based on angiography findings decision was made about further definitive treatment. It consisted of either using antiaggregating drugs (acetyl salicylic acid; 150 mg/day) if no significant postthrombectomy stenotic lesion was found or subjecting patients to further surgical revascularization in the form of bypass were significant stenosis or occlusion was identified. Group B consisted of 40 patients; all of them received conventional heparin anticoagulation therapy supplemented with vasoactive infusion treatment (Pentoxyohylline 300 mg/day) during period 1998-2004. On the third day of hospitalization oral anticoagulation (Sintrom) was included in the therapy protocol using dosage 2-8 mg/day in order to achieve INR 2-4, once therapeutic INR was obtained heparin was withdrawn. Study was clinical, designed as retrospective prospective and was conducted at the Clinic for vascular surgery in Sarajevo. RESULTS Mean age in group A was 66,5 years and in group B it was 65,78 years. Lenght of hospital stay in group A was 13,78 days while in group B it was 34,25 days (P value < 0,001). Limb salvage rate was 70% in group A and 17,5% in group B (P value < 0,001). In group A, nine amputations were performed (22,5%) while in group B we had to perform 38 amputations (95%), P value < 0,001. Only one reamputation was performed in group A (2,5% of patients) while in group B ten reamputations were performed (25% of patients). Mortality rate between groups was not statistically significant (P value < 0,077). CONCLUSION Surgical thrombectomy as introduction to definitive treatment of critical limb ischemia caused by atherothrombosis gives statistically superior results in comparison to conservative treatment.