The medical informatics as the separate medical discipline very quickly gets developed, both in Bosnia and Herzegovina. In our country, the medical informatics is a separate subject for the last ten years, regarding to the Medical curriculum at the biomedical faculties in Bosnia and Herzegovina is in accordance with the project of the education related to Bologna declaration and the project EURO MEDICINA. Last year the Chair of the Medical Informatics of the Medical Faculty in Sarajevo celebrates ten years of its existence. The research was performed using the separate questionnaire patterns data carriers with the defined characteristics for the quality assessment of the performed course. The total attitude of the assessed students speaks about dominantly expressed satisfaction with the majority of the parameters that are important for assessment of the quality and the tuition contents which were evaluated during the questionnaire. The education in the field of the medical informatics is based at the concept which is used in the developed countries of the world, and according the recommendations of the working groups of the European and world association of the medical informatics. The theoretical and practical teaching and training performance in the wholeness is performed by use of the computer equipment, and the final knowledge check of the students also is performed using the Data Base Management System MSAccess specifically designed to cover full teaching and training material by using questions set in the data base which encircled nearly 1500 questions combinations. In this paper author presents ten years of experience of medical informatics education at biomedical faculties in Bosnia and Herzegovina.
Distance learning or learning from the distance represents the educative technique with occupies all more significant place in the actual medical education of the healthcare workers at the international plan, specuale in the domains of the postgraduated and continuous medical education. It represents the educative technique of the significant effectivness, wich has to have at the disposal both adequate technological infrastructure as well as the previous education of the lecturer and users, adapted teaching plans and evaluation mechanisms of knowledge. By use of the rich choice of technological models, in relation to the traditional method of learning, enables the simultaneous education to the great number of students of the various profiles, the approach to all the relevant data basis as well as the mechanism of the evaluation knowledge institutions and the lectures.
Medical (health) informatics occupies the central place in all the segments of modern medicine in the past thirty years--in practical work, education and scientific research. In all that, computers have taken over the most important role and are used intensively for the development of the health information systems. Following activities develop within the area of health informatics: health-documentation, health-statistics, health-informatics and biomedical scientific and professional information. The medical informatics as the separate medical discipline very quickly gets developed, both in Bosnia and Herzegovina. In our country, the medical informatics is a separate subject for the last ten years, regarding to the Medical curriculum at the biomedical faculties in Bosnia and Herzegovina is in accordance with the project of the education related to Bologna declaration and the project EURO MEDICINA.
Medical documentation is a very important part of the medical documentalistics and is occupies a large part of daily work of medical staff working in Primary Health Care. Paper documentation is going to be replaced by electronic cards in Bosnia and Herzegovina and a new Health Care System is under development, based on an Electronic Family Registration Card. Developed countries proceeded from the manual and semiautomatic method of medical data processing to the new method of entering, storage, transferring, searching and protecting data, using electronic equipment. Currently, many European countries have developed a Medical Card Based Electronic Information System. Three types of electronic card are currently in use: a Hybrid Card, a Smart Card and a Laser Card. The dilemma is which card should be used as a data carrier. The Electronic Family Registration Cared is a question of strategic interest for B&H, but also a great investment. We should avoid the errors of other countries that have been developing card-based system. In this article we present all mentioned cards and compare advantages and disadvantages of different technologies.
The family medicine as the determination of the reformators and the strategies of the action in BiH is given in the form of the legal solution in the organization of the primary healhtcare action in BiH given in the form of the legal solution in the organization of the primary healthcare protection (the law about the healthcare protection--official newspaper F/BiH No 29/97). The fact is given the alternative solution--the team of the family medicine or the team of the medicine. Besides this there exist also some essential questions about the registration of the patients for the family medicine teams make complex the forming of the next of the family medicine. Besides that there are also some essential questional about the registration of the patients for family medicine teams--whethers that they registrar all the citizens or only the insureds to which is insured the healthcare protection though the medicine--werther are being registered all the citizens, whom belong the active ensured whom is ensured the healthcare protection through the institutions for the work medicine, the students and sportsmen who also have their institution etc. The further problem, when is in questions the patients registration of the patients, is the nonexistence of the reliable statistical data about the number, sexual inhabitants, as is known all the estimates are being done on the basis of the estimation of the federal institution for statistics. Therefore the registration of the family and the individuals for the family medicine teams will be rather painstaking.
The organized health care in Tuzla region begins by the establishment of hastahana in Tuzla 1874 year, when thanks the first graduated physician Dr. Mehmed Serbic Sami was opened the Vakuf's hospital in Tuzla, which he success fully lead to his death 1918 year. The great role in the treatment of the become ill inhabitants played the general hosptals, established during Australia-Hungarian period (Tuzla - 1886, Brcko - 1886...) whose capacities later were enlarged, and their health staff enabled at the universitets in the surrounding countries, later also in B&H, during the past period. The significant role in this played also the series of the health educators from which some will become the names in the segment of the health-care in this region and wider. About them and the institutions in this region, which merited not to be overlet to for fulness, the authors write in this paper.
In the last twenty years, the European office of WHO with its expert groups designated CVD as a problem of top priority in European health policy. The documents of WHO related to CVD, and their directives to member countries, are illustrated in this paper. The authors emphasize that according to available data, CVDs are cause of 40% of total mortality among the European population above the age of 75. In Bosnia and Herzegovina, CVDs are the leading cause of mortality in the last few years. The difference in incidence and prevalence of CVD among European countries is emphasized in the paper. According to the available data of WHO, the greatest incidence and prevalence of these diseases is in East European and Central European countries and the lowest in Mediterranean countries, with the exception of Bosnia and Herzegovina. The evaluation of the present state of frequency of CVD in Europe and the projection of their trends in some countries until 2020 is given in the paper. An alternative projection of the trends of CVD in Bosnia and Herzegovina, including a variant of application of organized preventive programs, is presented in the paper. Illustrative examples of the effects of preventive programs in some European countries, and possibilities of their application in Bosnia and Herzegovina are presented in this paper. Cost analysis of the application of preventive programs and their effects on the reduction of number of people affected by CVD in the short period until 2010 and 2020 is also elaborated in this paper.
Polytrauma with significant lesion of peripheral nerves is a specific war injury. It is also one of the most delicate problems in rehabilitation treatment because it requires a close cooperation with surgeon and timely surgical interventions. Based on our experience, the best results in the treatment of injured persons with lesion of peripheral nerves have been accomplished after the surgical treatment. Results in the neurolysis were better than those accomplished in neurorrhaphy. Total of 436 patients with lesion of peripheral nerves were recorded and 56 patients with plexus lesion. Out of this number, 78 patients (about 15%) had surgical treatment (41 neurorrhaphy and 37 neurolysis). Due to lack of adequate ENMG diagnostics, the objective valorisation of treatment outcome was not possible.
Acute lumbar syndrome occurs suddenly and is accompanied with strong pain in the lower part of the back. The most frequent APLS causes are vertebral (herniation of intervertebral disc, subluxation of intervertebral disc, subluxation of intervertebral joint, fracture of vertebra--traumatic or pathological), or extravertebral (subluxation of sacroiliac joint, acute bursitis of iliolumbar segment, muscle injuries or injuries of tendo-ligamentous apparatus of lumbosacral region). The treatment of acute lumbar painful syndrome is classified as medical, alternatively medical, surgical and combined. On the basis of durable experience, "Praxis method" as a treatment of lumbar pain (general and acute) is being applied in the Centre for Physical Medicine and Rehabilitation "Praxis" in Sarajevo. During the period from 1996 to 2000, the total number of 5.663 patients were examined in the centre "Praxis". Out of that number, 17.7% (1.003) of patients had acute lumbar painful syndrome (ALPS). Immediately after the therapeutic manipulation, which included "Praxis method, 31.5% (317) patients experienced the cessation of pains followed by ending of the treatment. The length of treatment for the rest of patients lasted: 1-7 days in 412 or 41.07 % of patients, 8-21 days in 195 or 19.48% of patients, and more than 21 days in 79 or 7.88% of patients. For all patients (1.003) the average treatment duration was 6.6 days. The recidivation occurred in 127 patients (12.66%). Throughout the treatment successfulness estimation according to clinical results scaled from 0 to 5, it was confirmed that out of the total number of 831 patients (82.85%) results were excellent in 459 patients (45.76%) or very good in 372 patients (35.09%). The average age of patients was ranging between 35 and 45 years (621 patients or 61.9%). The male/female distribution was 2:1.
The war injuries are the most frequent multiple, with the difficult distructions of the tissue and the lesions of the peripheral nerves. By the injuries, the lesions of the nerv system represent the delicate problem for the physical medicine and the rehabilitation during the siege of Sarajevo (1992-1995), in the injuries with the lesions of the peripheral nerves, if they are not treated in the frame of the multiple las urgent, they are postponed the operative treatments longer than three months. This is from the aspect of the successfullness, prognostically and therapeutically, the limiting moment. The successfullness of the operative treatment of the lesions of the peripheral nerves significantly depends on that whether the operation was performed incide tree months. The more difficult consequences in these injuries can appear if simultaneously with the taking care of war injuries does not perform adequately surgical treatment adn the in time physical therapy trough the sufficient long time period. On the four year sample was analyzed the success fullness of the rehabilitation of the injuries of the upper extremities with the lesions of the peripheral nerves. Clinically, uniform, we valorized the success fullness of the treatment of all the patients by the marks from 0.5. In the complete sample the excellent success of the rehabilitation we confirmed in more than a half of patients. The better results show the group of the operated patients, in which is performed neuropathia or neurolisis. The capability of the regeneration of the injured peripheral nerves offers the real possibility for extraordinary recovery also in the most difficult injuries, then the preventions of the significant number of the consequences.
In this paper is valoriziaed the successfulness of the treatment of 1,431 patients with the verification disc hernia (CT, MRI) in the surgery for the physical medicine and the rehabilitation in the period from 1966 till 2000 year, by "Praxis method". It is established that in the structure of the treated patients by the structure of the treated patients by the application of this method the best results were achieved by disc hernia in the level L4-L5 without the motor deficiency (567 patients), with the average treatment length 24.38 days and the average estimation of the results 4.06 and then in patients with the disc hernia L5-S1. In disc hernia without diagnostic verified disorder of the motorics, the result of the physical therapy and the rehabilitation was better. This can be observed from the treatment successfulness estimation and the treatment length and number of days of the treatment. The longest treatment was by hernia L5-S1 with the motor disorderly (43.10 days), and the shortest in the disc lesion at the level L4-L5 (24.38 days). Among the patients with disc hernia which in this period were treated was operated only 58 or 4.05%. The age structure of the treated patients with disc hernia amounted averagelly 49.95 years, and the greatest number of the treated belonged to the age group 35 to 44 years.
Psychoactive drug misuse, as bad habit, is local ethiologic factor of periodontal diseases, and it represents the significant socio-medical problem. The aim of study is: to establish the values of plaque and gingival index in psychoactive drug addicts. The study has been carried out in 42 patients. Experimental group consists of psychoactive drug addicts, and control group consists of patients who have not used psychoactive drugs. The plaque and gingival index show significant difference between experimental and control group. Psychoactive drug misuse has the influence to increased adherence of dental plaque and gingival inflammation, and therapeutic approach is at multidisciplinary level.
Bosnia and Herzegovina, in the global transition, lives to see also the changes in the reconstruction of the health care system and his different segments. One from these segments of the healthcare is the urgent medicine. In this segments they attempt to find the optimal solutions of the organization of the polytraumatized patients in the centers for urgent medicine in the out hospital and the hospital institutions. With the programmes of the war and postwar conditions. To the programmes of the health involved some of strategies and concepts in this field from the developed countries and to us neighboring countries with those who we had tried to apply in the war and postwar conditions. Those solutions have to be accorded with the general conceptions of the development of healthcare in the future period in B&H, and the response, and supported on the organizational, functional, technologic and the income--based changes of the prehospital and hospital institutions, first of all in the city Sarajevo, and then also in other regions of Bosnia and Herzegovina. At the example of the transformation of the system of taking care of the polytraumatized patients in the Center for urgent medicine the Clinical Center of the University of Sarajevo the authors suggest some kind of the unique solution for the rest healthcare of the institutions of the similar types in Bosnia and Herzegovina.
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