Background/Aim: The primary objective of this study was to conduct comprehensive research and analysis of patient-generated content related to Achilles tendon surgery on the social media platform Instagram. The aim was to gain deeper insights into patients' experiences during the perioperative period, which may contain valuable information pertinent to their condition, information of which the physicians may be unaware. Methods: A search was conducted on the Instagram database, covering a period of 78 months from February 2015 to August 2021. Posts utilizing the hashtags "#achillessurgery" and "#achillesrepair" were included in the analysis. Posts were assessed using a binary scoring system, considering variables such as tone, media format, return to work, rehabilitation or physical therapy, return to sports, images related to the ankle (e.g., scars, stitches, casts, dressings, walking boots), activities of daily living, and pain. Results: A total of 500 posts were reviewed, and a positive tone was observed in 77.8% of these. The average Instagram like ratio for these posts was computed as 9%. Statistical analysis revealed a significant relationship between post content and tone status (P=0.001). Specifically, within the positive tone group, informative content about the disease was comparatively lower and statistically significant when compared to exercise training and patient experience (P=0.001). Additionally, exercise training posts were found to be significantly lower than patient experience posts (P=0.001) within the positive tone group. In contrast, within the negative tone group, patient experience posts were significantly higher compared to informative content and exercise training posts (P=0.001). Moreover, the quantity of informative posts markedly surpassed the number of posts related to exercise training (P=0.001). Conclusion: In the positive tone category, people tended to emphasize personal experiences and participate in posts related to exercise training rather than actively seeking or exchanging information about the disorder. On the other hand, within the negative tone group, individuals were more likely to share adverse experiences, pursue support, and seek a deeper understanding from others. Their priority may also lie in sharing and gaining information specifically about the disorder. Our exploration of the use of social media platforms to delve into patient perspectives on Achilles tendon surgery provides an alternative insight into patients' experiences with the surgical process. By comprehending the content shared by patients on social media, surgeons may gain an improved opportunity to assess and address the surgical experience of their patients more effectively, ultimately contributing to enhanced patient care.

Background/Aim: Most scoring systems in healthcare take into account the physical condition and pain status of a patient, but the impact of society on the individual is ignored. The aim of our study was to evaluate the social media posts made by patients regarding lumbar discectomy surgery. The objective was to identify and explore concerns and issues that may not be immediately evident during clinical evaluations but are significant to the patients themselves. Methods: Public posts with the hashtags #discectomy, #lumbardisectomy, and #discectomyrecovery were examined on the Instagram application. The tone of the post, return to sports (RTS), rehabilitation or physical therapy (PT), return to work (RTW), incision site (e.g., scarring, sutures, and dressing), pain, activities of daily living (ADL), and X-ray/magnetic resonance imaging (MRI) data were evaluated. The "Instagram likes ratio" was determined by dividing the total number of likes received for each post by the number of followers. Results: 272 posts were assessed, and 77.9% of them exhibited a positive tone. The topic that was most frequently discussed was ADL, which was discussed in 24.6% of the posts. Statistical analysis demonstrated a significant association between positive tone and ADL, as well as positive tone and RTS (P<0.001). A statistically significant correlation was observed between negative tone and neurological deficits, pain, and X-ray/MRI findings (P<0.001). Conclusion: Our study offers a unique perspective on the experience and satisfaction of patients who have undergone lumbar discectomy. Neurologic deficits and pain were notably significant in the negative posts. However, in general, the majority of the posts maintained a positive tone. The results could provide insights into patients' experiences and perspectives that can potentially inform healthcare professionals in providing more comprehensive and patient-centered care.

PURPOSE OF THE STUDY The hip fracture is the leading cause of disability and deaths in elderly. If left untreated, the hip fracture results in inability to walk, and therefore the patient is dependent on the other's people help. The aim of this study was to determine the predictive values of the functional status, present comorbidities, and the types of treatment on the long-term functional status and mortality in patients with the hip fracture. MATERIAL AND METHODS We analyzed the data about the patients with the hip fractures treated in the period between 01.07.2006. and 01.07.2016., with the mean follow-up period between 34.3±4.9 months. The data included radiographs, age, comorbidities, functional status on admission, functional status on discharge, and follow-ups. RESULTS Female sex, increasing age, and poorer functional status upon admission, conservative treatment, trochanteric fracture, the presence of neurological or lung disease, diabetes, were all significant risk factors leading to poorer functional outcomes on the latest follow-up (p < 0.05). On the other hand, the patients who were mobile upon admission had a longer survival (38.1±3.51 months) as compared with the other patients (12.3±5.1 months; χ2=25.202, p = 0.001). Besides, the results of this study revealed that the direct, statistically significant relationship exists between the untreated internal and neurological diseases, and increased mortality and poorer functional outcomes on the latest follow-up. CONCLUSIONS These results are useful for the orthopedic and trauma surgeons, who are treating these patients, the physical medicine and rehabilitation specialists, who are performing the rehabilitation of these patients, but also the health policy makers, who may promote the programmes of healthy aging (treating the diseases, maintaining fitness, etc.) Key words: hip fracture; comorbidity; mortality; functional status.

Aim To measure a calibre of radial and ulnar septocutaneous perforators at the anterior forearm, and to count its number in proximal, middle and distal thirds. Methods The study was conducted on 50 fresh amputated forearms (trauma, tumours) in the period between January 2012 and December 2021. Forearms were collected from several hospitals in Belgrade, and analysed at the Institute of Anatomy, Medical School, University of Belgrade, Serbia. Injection of ink-gelatin and fine dissection of autopsy material was performed on 30 forearms, and corrosion method with injecting methyl methacrylate for 3D analysis on the other 20 forearms. Results A mean calibre of septocutaneous perforators on the radial artery was 0.53±0.46 mm (0.2-0.85). Averagely, there were 8.1 radial artery septocutaneous perforators - two perforators on the proximal third, 3.7 on the middle third, and 2.7 on the distal third. The mean calibre of ulnar artery perforators was 0.65±0.35 mm (0.18-1.8). The average number of septocutaneous perforators of the ulnar artery was 5.6; 1.2 on the proximal third, two on the middle third, and 2.2 on distal third. Conclusion Determination of the origin, calibre and spreading directions of the arterial septocutaneous perforators on the anterior forearm provide quantification of data about arborisation of radial and ulnar septocutaneous perforators at the anterior forearm. Clinical relevance of those anatomical data is in defining of safe locations and dimensions of forearm fasciocutaneous flaps in plastic surgery.

Background: From 2013 the World Medical Association’s Declaration of Helsinki explicitly requires pre-registration of a study involving human subjects. The registration gives a chance for improvement of design and avoidance of bias. Objective: The aim of this article was to describe process of bearing decision to create regional registry of clinical studies for Balkan countries. Methods: After finding relevant studies about research registries and designing the concept and structure of future regional registry an article was published in IJBH journal. The article was than used as basis for discussion at 2020 meeting of Academy of Medical Sciences of Bosnia and Herzegovina (AMSBH), and final decision was made by the Academy to create the research registry. Results: Regional registry of clinical studies will be under the auspices of AMSBH and web-based, with the option of online registration of new studies. The data required to be entered in the moment of registration relate to key elements of research plan: topic, variables, sample, type of the study and the study population. After applying for registration of a clinical study, the authors will soon receive the review made by the AMSBH expert committee. The application could be accepted, rejected or returned for major or minor revision. After an application is accepted, it will be deposited in the searchable database and given the registration number. Conclusion: The AMSBH’s decision to create the regional registry of clinical studies will satisfy needs of researchers from Balkan countries in the first place, who share cultural and lingual similarities. It will also help with increasing standards of clinical research in the region.

Background: Enormous number of medical journals published around the globe requires standardization of editing practice. Objective: The aim of this article was to enlist main principles of editing biomedical scientific journals adopted at annual meeting of Academy of Medical Sciences of Bosnia & Herzegovina (AMSB&H). Methods: The evidence for writing this Guideline was systematically searched for during September 2020 in the PUBMED and GOOGLE SCHOLAR databases. The inclusion criteria were: original studies, systematic reviews, invited expert opinions, guidelines and editorials. The exclusion criteria were narrative reviews and uninvited opinion articles. The retrieved evidence was analyzed by members of the AMSB&H, then discussed at 2020 annual meeting of the AMSB&H and adopted by nominal group technique. Results: In total 14 recommendations were made, based on A to C class of evidence. The editors should educate potential authors and instruct them how to structure their manuscript, how to write every segment of the manuscript, and take care about correct use of statistical tests. Plagiarism detection softwares should be used regularly, and statistical and technical editing should be rigorous and thorough. International standards of reporting specific types of studies should be followed, and principles of ethical and responsible behavior of editors, reviewers and authors should be published on the journal’s web site. The editors should insist on registration of clinical studies before submission, and check whether non-essential personal information is removed from the articles; when essential personal information has to be included, an article should not be published without signed informed consent by the patient to whom these information relate. Conclusions: Principles of editing biomedical scientific journals recommended in this guideline should serve as one of the means of improving medical journals’ quality.

Aim To explore the experiences of registered nurses in assessing postoperative pain in hip fracture patients suffering from dementia in nursing homes. Methods The study was designed as a qualitative study using data from a self-reported questionnaire form. Data were collected through the self-administered questionnaire with 23 questions, mainly addressing demographic and social data, information about communication and pain assessment. Results All nurses reported that large part of verbal communication with dementia patients was lost, and non-verbal communication was very important to optimize the care of these patients in postoperative situations. An assessment of pain in patients with dementia and hip fractures was a complex process because cognitive ability of these patients was reduced. Conclusion Registered nurses need to know various and different forms of evaluation and tools to assess the experience of pain in patients with dementia who had undergone surgery for hip fractures. This is a complicated task, which requires a great deal of time, and means that nurses must work together with other medical staff, using a holistic approach.

In spine deformity surgery, iatrogenic neurologic injuries might occur due to the mechanical force applied to the spinal cord from implants, instruments, and bony structures, or due to ischemic changes from vessel ligation during exposure and cord distraction/compression during corrective manoeuvres. Prompt reaction within the reversible phase (reducing of compressive/distractive forces) usually restores functionality of the spinal cord, but if those forces continue to persist, a permanent neurological deficit might be expected. With monitoring of sensory pathways (dorsal column–medial lemniscus) by somatosensory-evoked potentials (SSEPs), such events are detected with a sensitivity of up to 92%, and a specificity of up to 100%. The monitoring of motor pathways by transcranial electric motor-evoked potentials (TceMEPs) has a sensitivity and a specificity of up to 100%, but it requires avoidance of halogenated anaesthetics and neuromuscular blockades. Different modalities of intraoperative neuromonitoring (IONM: SSEP, TceMEP, or combined) can be performed by the neurophysiologist, the technician or the surgeon. Combined SSEP/TceMEP performed by the neurophysiologist in the operating room is the preferable method of IONM, but it might be impractical or unaffordable in many institutions. Still, many spine deformity surgeries worldwide are performed without any type of IONM. Medicolegal aspects of IONM are different worldwide and in many cases some vagueness remains. The type of IONM that a spinal surgeon employs should be reliable, affordable, practical, and recognized by the medicolegal guidelines. Cite this article: EFORT Open Rev 2020;5:9-16. DOI: 10.1302/2058-5241.5.180032

Aim To explore the experiences of anaesthesia nurses in assessing postoperative pain in patients undergoing total hip and/or knee arthroplasty. Methods Data were collected through four focus group interviews (FGI) using the critical incident technique (CIT). The participants were six men and 12 women, all registered nurses with further education in anaesthesia with at least five-year experience of caring for patients on a postoperative ward. Results Maintaining communication with orthopaedic patients, different ways to assess pain, the assessment of unresponsive patients, using pain assessment scales and different work circumstances influencing their use, were stated as the main problems the nurses emphasize while assessing the pain of patients. Conclusion Skills related to observing the behaviour and experience of pain in different individuals are needed to ensure an understanding of patients' pain, as well as the patients' ability to estimate their pain, where the intensity of the pain varies in different patients. Further studies are needed to examine the way health professionals assess pain, depending on the patients' ability to transform their pain from a subjective feeling into an objective numeric grade. The way individuals assess their pain differently and the way the resulting knowledge and experience of postoperative care may help nurses and other health-care professionals.

Aim To explore the experience of registered nurses in assessing pain in hip fracture in patients with dementia in the postoperative setting. Methods The study questionnaire contained 23 items mainly addressing demographic and social data, information about communication and pain assessment, attention and awareness of the health-care professionals on the ward and suggestions for improving nursing. Results The nurses claimed that they began their assessment of pain in patients with dementia first by observing the patient and making a visual assessment of pain, after which they began to communicate with these patients; majority of dementia patients with hip fractures displayed more facial expressions of pain than patients without dementia. All the nurses agreed that the more severe the patient's dementia was, the less clear the facial expressions and that this in turn made it difficult for the nurses to take care of such patients. Body language was the most common way the patients with dementia and hip fractures expressed their pain. Assessing the pain of a dementia patient with hip fracture and interpreting a non-verbally communicative patient was experienced as very difficult by all the nurses. Conclusion The nurses found that the fact that they had not attended any courses on dementia and pain assessment in those patients made their work more difficult; they need to know more and to have more information about those patients and their needs for a more comprehensive exchange of information between the hospital wards and the patients' care homes.

Introduction: An ankle joint is a modified hinged joint consisted of three bones and ligaments. Muscles that result in plantar, that is, dorsal flexion, work through this functional unit. Aim of the Study: The aim of the paper is to analyze injuries of supra-syndesmotic fractures of the fibula, which were treated operatively with or without syndesmotic screw as well as to evaluate clinical results of the treatment after 3, 6 and 12 months. Patients and Methods: A retrospective-prospective study consisted of 102 respondents treated at the Clinic for Orthopedics and Traumatology UCC Sarajevo. Patients were divided into two groups. The first group (G1) consisted of 48 (47%) respondents who had met the required criteria – placement of a syndesmotic screw during the operation, and the second group (G2) consisted of 52 (53%) respondents who did not have a syndesmotic screw inserted during the operation. Results: The average value of the AOFAS score after 12 months in the group G1 was 91.15 points. The average value of the AOFAS score in the group G2 was 89.15 points. The value of the T-test was 1.688, p = 0.095 (p> 0.05). There was no significant difference in the average AOFAS score between the G1 and G2 respondents. Conclusion: The results obtained in the study confirm that there is no significant difference in the final outcome of the treatment between the G1 and G2 respondents. There is no significant difference in duration of treatment and hospitalization between groups G1 and G2. Significantly better average values regarding mobility for patients in the group G2 during the check-ups 3 and 6 months after the surgical procedure were transient.

AIMS AND OBJECTIVES To study a group of immigrants' experiences regarding interactions with primary health care through an interpreter. BACKGROUND Approximately, 230 million people are resettled outside of their own home country. Thus, more than 3% of the world's population are migrants. It is a major challenge for health care providers to satisfy immigrants' needs for individualised health care services. DESIGN Qualitative study. METHODS Focus group interviews were conducted with four groups of immigrants (n = 24) from Bosnia and Herzegovina, Croatia, Kosovo and Somalia. The group interviews were audio recorded, transcribed and analysed, and the text was categorised using the content analysis method. RESULTS Participants' expectations of the interpreter-mediated consultations were high, but not always fulfilled. Interpreters being late, lacking professionalism or lacking knowledge in medical terminology and the use of health care professionals or relatives as interpreters were some of the problems raised. CONCLUSION A well-organised, disciplined interpreter service with professional and competent interpreters is needed to overcome problems regarding clinical consultations involving interpreters. A satisfactory language bridge has a significant impact on the quality of communications. CLINICAL IMPLICATION Interpreter services should be well organised, and interpreters should be linguistically, culturally and socially competent, as these factors may have a significant impact on consultation outcomes. Using relatives or staff as interpreters can sometimes be a solution but often results in an unsatisfactory clinical consultation.

Introduction: In this article are demonstrated differences in the aspects of the metabolic syndrome (MSy) between genders, as well as the association of MSy and neuropathy. The aim: The aim of our study was that in patients with newly discovered metabolic syndrome of both sexes make comparison of fasting blood glucose levels and after oral glucose tolerance test, as well as neurophysiological parameters of n.medianus and n.ulnaris. Patients and methods: All participants were examined dermatologically. The analysis included the 36 male and 36 female respondents with a newly discovered MSy. Results: The average age of men was 52.75±7.5 (40-65) years and women 52.1±7.7 (38-67) years. The average value of fasting blood glucose in women was 5.86±0.87 (4.5-8) mmol/L, and non significantly higher in men (p=0.0969) as 6.19±0.8 (4.7-8) mmol/L. Average values of blood sugar 120 minutes after oral glucose tolerance test were not significantly different (p=0.7052), and was 5.41±1.63 (3.3-9.7) mmol/L in women and 5.27±1.52 (2.7-9.8) mmol/L in men. Median motor velocity were significantly higher in women for n.medianus on the left (p=0.0024), n.ulnaris on the left (p=0.0081) and n.ulnaris on the right side (p=0.0293), and the median motor terminal latency were significantly longer in n.ulnaris on the left (p=0.0349) and n.ulnaris on the right side (p=0.011). There was no significant difference in the sensory conductivity velocity in n.medianus and n.ulnaris between the groups, but the amplitude with the highest peak of the sensory response was significantly higher in n.medianus on the left (p=0.0269) and n.ulnaris on the left side (p=0.0009) in female patients. Conclusion: The results indicate that there are differences in neurophysiological parameters of the investigated nerves between the genders, and that tested nerve structures in the course of MSy are affected slightly more in men. There were no significant differences in skin changes between genders.

Introduction: Degenerative disc disease is one of the most common reason for low back pain in a physical active population. The shape of the spine, especially reduction of lordosis, may have an important role in ethiology of lumbar disc degeneration. The aim of this study is to assess is there any differences within genders when evaluate lumbar spine and pelvic parameters in patients with a DDD. Materials and Methods: A prospective survey has been conducted in the Spine surgery department of Civil Hospital in Strasbourg (Service du Rachise, L'Hopital Civil, Strasbourg, France) during the period between January 1th, 2005 and December 31st, 2008. We have analyzed x rays and spino-pelvic parameters of 63 patients among of 80 patients with degenerative disc disease (DDD) of lumbar spine in which total disc arthroplasty (TDA) have been performed at one level. Standing lateral full spine x rays has been done before surgery and at final follow-up 3 years later. Following parameters were analyzed: lumbar lordosis (L1-S1), intervertebral angle, anterior and posterior disc height, sacral slope, pelvic tilt and pelvic incidence. Results : Mean follow-up time was 44 months. 45 females and 18 males patients with a mean age of 41,38 year were evaluated. The preoperative values of lumbar lordosis and sacral slope was significantly higher in a females with a DDD at L4-L5 segment. The same result has been seen and after the surgery. There have not been statistical differences these values between genders with DDD at L5-S1 segment, nor preoperatively, nor postoperatively. Conclusion : Although reduction of lordosis is pointed out as an important role for DDD we have not found that in our study that may suggest that DDD has complex etiology.