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 anaesthetist nurses in brief meetings with immigrant patients in the perioperative setting. Methods The study was conducted through open individualised interviews using open-ended questions. Eighteen anaesthetist nurses (six men and twelve women) participated in the interviews. Their age varied between 35 and 65 and they had worked as anaesthetist nurses for a period between six and twenty eight years. The text was analysed using qualitative content analysis. Results Meetings with immigrant patients made nurses with less experience to prepare more, to study behaviour of these patients and to ask their older colleagues for advice. More experienced nurses acted on the basis of their previous experience and treated the patients in the same way as before. They also emphasised the great responsibility and wider scope of assistance needed by these patients than those born in Sweden. The majority of nurses begin the meetings with these patients by requesting an interpreter, while some nurses begin the meeting directly with the patient and, if they see it is not going well, they request an interpreter. Conclusion Nurses need better guidelines and education in how to deal with the legislation relating to immigrant patients in order to handle the situation more effectively. Training in cross-cultural care should be improved to help nurses deal with stress through co-operation with the Migration Board and others. In order to provide for good communication and patient safety professional interpreters should be used.

Aim To investigate existence of scientific support for linking differences in the experience of pain to ethnicity. Methods The study was designed as a systematic literature review of qualitative and quantitative studies. The inclusion criteria were scientific studies published in scientific journals and written in English. Studies that described children's experiences and animals were excluded. There were 10 studies, one qualitative and nine quantitative. Results The result was divided into two main sections. The first section presents the results of investigated material regarding different ethnic groups, the groups' different experiences with regard to pain and its treatment focusing entirely on the patients' perspective. Several studies have revealed major differences in the way individuals perceive their pain, using various pain evaluation tools. The second section explained different coping strategies depending on ethnicity and showed that different ethnic groups handle their pain in different ways. Conclusion Healthcare professionals have a duty to pay attention to and understand the patients' experience of their disease and suffering and, as far as possible, mitigate this using appropriate measures. For this purpose, ethnic, cultural and religious differences between different patients need to be understood. It is necessary to continue to study ethnic differences in reporting and predicting pain and its consequences, including the assessment of variables associated with pain, as well as examining the use of prayer as a form of dealing with pain, with an evaluation of various effects of such different influences.

Background: Chemical pleurodesis is generally accepted palliative dyspnea therapy and preventive of re-accumulation of pleural fluid in patients with malignant pleural effusions. Aim: Comparative analyses of efficiency of chemical pleurodesis between Video Assisted Thoracoscopic Surgery (VATS) and standard thoracostomy. Methods: From 01.01.2016-01.01.2017 at the Clinic for Thoracic Surgery of University Clinical Center (UCC) Sarajevo retrospective analysis was performed. Studied patients underwent VATS pleurodesis (G1) and standard thoracostomy pleurodesis (G2), with 60 in each group, respecting defined inclusion and exclusion criteria. Pleurodesis success was examined radiologically over the next three months. Results: Average age of all patients was 63.97±8.75 years. Gender related, 45% were men and 55% were women (F/M=1.47:1). Average hospitalization was 7.22±1.37 (G1: 6.68±1.16; G2: 7.44±1.40; Mann-Whitney U-test: p=0.0016) days. Average thoracic drainage duration was 5.45±1.69, (G1: 4.28±1.15,G2: 6.05±1.58; Mann-Whitney U-test p<0.0001) days. Pleurodesis success after first month was 98.30% in G1, 91.60% in G2 (G1 vs. G2; p=0.2089); after second month was 98.30% in G1, 78.30% in G2 (G1 vs. G2; p=0.0011) and after three months was 91.60% in G1, 63.30% in G2(G1 vs. G2; p=0.0006). Average dyspnea degree (0-5) after the pleurodesis was 0.050±0.22 in G1 and 0.62±0.76 in G2 (Mann-Whitney U-test; p=0.0001). Complication were noticed in 9.2% patients, in G1 3.3%, 15.0% in G2. Conclusion: Difference in pleurodesis efficiency between the G1 and G2 was established after second month and was even more evident after third month in favor of G1. Results show the significant statistical improvement of the degree of dyspnea in G1 as opposite to the G2.

Introduction: Malignant cells invasion of lymphatic drainage represents the basic precondition of metastasis and the disease progress. The invasion of tumor depends on its pathomorphologic characteristics, out of which one of the most significant role is the type. Aim of the Study: Descriptive analysis of operated patients, estimation of frequency and representativeness of the stated types of NSCLC in the monitored group, analysis of malignant cells of lung cancer in lymphatic drainage on the basis of the type of primary tumor. Patients and Methods: The study included 331 patients, who underwent the surgery during which the malignant infiltration was removed, in addition to the dissection of lymph nodes drainage. Results: Out of the total number of operated patients, 257 of them were male gender, while 74 were female gender, with the average age of 63.52 years (21-80). The relation of gender structure of the patients in relation to gender was statistically significant (p=0.00). The ratio between squamous cell carcinoma to adenocarcinoma was 182:140, while the other types of tumor were insignificant. Statistically, there was no significant difference in the frequency of two most common types of lung cancer (χ2test= 3.02; p=0.09). There was no statistically significant connection between the type of tumor and N1 metastasis (χ2=1.55; p=0.46), as well as in the ratio between the type of tumor and malignant infiltration of lymph nodes, level N2 (χ2=2.33; p=0.32). Conclusion: There is no connection between the type of lung cancer and invasion of levels N1 and N2 of lymph nodes.

Background: We aimed to explore the background of refugees emigrating to Sweden and their situation in the new country with special focus on their contacts with the Swedish healthcare system. Material and methods: Our study has a qualitative design. Data was collected between January and October 2013 during face-to-face interviews using open-ended questions. A qualitative content analysis was carried out in accordance with the Graneheim and Lundman method (2004). The participants were 8 women and 7 men, aged between 65 and 86 years who had emigrated from Bosnia and Herzegovina. They had lived in Sweden between 13 and 21 years. Results: The findings revealed that the participants themselves experienced that change of scenery, culture and language influenced their own well-being. The most important finding was that language and communication difficulties are experienced as the major problems. These difficulties implied that all informants were forced to seek help from their children or to use an interpreter when they visited various healthcare institutions. Conclusions: Health care professionals need to be aware of the diverse needs of various ethnic groups in Sweden, some of whom may carry traumatic experiences that could influence their health. In order to provide trans cultural care, a professional staff needs to know that historical, political and socioeconomic factors may influence ethnic minorities. Health care staff needs to recognize that social problems might be medicalized. In particular this article emphasizes the problems associated with language.

Introduction: Approximately only 20-40% of those who suffer from nonmicrocellular lung cancer at detection of disease are candidates for operational treatment. Pre-operational use of inductive oncological therapy at 6075% of cases “takes” the disease into lower level, while at 50% of cases it is possible to do resectional treatment. The aim of work is to demonstrate efficiency of inductive oncological treatment in relation to possibility of resection. Material and methods: This analysis includes 62 patients who underwent different surgical treatment, and after inductive oncological treatment. Results: There is a ignificant statistical difference in frequency of appearance between the two most common sorts of cancer (χ2=25; p=0), the same as statistically significant difference in frequency of certain sorts of cancer according to gender (p= 0). Using Fisher exact test, there was no statistically defined significant dependence between the sort of cancer and its sensitivity to chemotherapy (p=0,2) the same as there was not statistical dependency of chemo therapeutical sensitivity in relation to gender (p=1). Using chi-square test, there was no defined statistically significant difference in frequency of sort of operation in relation to sort of cancer (χ2=1; p=0,6). There is a presence of statistically significant positive connection between the days spent at intensive care and days spent at the ward of surgically treated patients (rho =0,63; p< 0,01) and also there is statistically significant dependence between the response to chemo therapy and days spent at intensive care (p=0). There is also defined statistically significant dependency between the sort of operational treatment and days spent at intensive care and at ward of standard care (χ2=17; p=0 vs. χ2=11; p=0). Conclusion: There is an evident relation of sort of surgical treatment and operational techniques to duration of post operational treatment.

Introduction. Treatment of rectal cancer needs additional preoperative improvements that would decrease tumor volume and move away the lower edge of the tumor from a dentate line, allowing a higher percentage of operability and higher percentage of AR for APR and sterilize potential locoregional tumor deposits. Surgery can accomplish these improvements by using radio and chemotherapy. Patients and Methods. From September, 2011 to September, 2013, 153 patients with rectal cancer were treated. Neoadjuvant radio and chemotherapy by the Swedish protocol were applied in 20 patients (13.07%) with T 2-4 stages. There were fifteen men (75%) and five women (25%), average age was 59.28 years. Long course therapy occurred in fifteen (75%) and short course in five patients (25%). When compared to the previous two-year period, the percentage of inoperable cancers was decreased by 0.9% (p = 0.61) during the period of application of neoadjuvant therapy. There were also some other differences: a number of APR was 19, i.e. decreased by 3.85% (p = 0.83) or for 10 patients when compared to the previous two-year period, when there was 29 APR. Conclusion. Neoadjuvant therapy may convert up to 60% (3 of 5) of inoperable patients into an operable group. The percentage of APR is lower by 3.5% (p = 0.83), i.e. 10 patients when compared to the previous two-year period and neoadjuvant radio and chemotherapy does not affect the anastomosis healing process and / or the occurrence of fistula and / or abdominal collection.

INTRODUCTION Isolated thoracic injuries are relatively common and they are on the second place as a cause of death overall trauma. Most patients with isolated thoracic injuries are treated on an outpatient basis while only serious cases are hospitalized. The basis of the treatment of thoracic trauma is efficient cardiopulmonary reanimation followed by an early detection and treatment of life threatening injuries. Less than 15% of patients with thoracic trauma require thoracotomy. PATIENTS Only the patients with exclusively isolated thoracic trauma were analyzed. RESULTS Based on initial diagnostic procedures initial conservative treatment was indicated and sufficient for 63.75% (204/320) cases while initial surgery treatment was necessary in 36.25% (116/320) of the injured. In relation to the type of surgery the thoracic drainage was performed in 81.03% (94/116) while thoracotomy and VATS procedure was necessary for 7.75% (9/116) of the injured. After the secondary examination or shorter monitoring of the status of the injured, the additional diagnostic procedure was suggested and performed in only 5% (16/320) of the injured. The average period of the hospitalization for all injured with isolated thoracic trauma was 5.9 +/- 4.0 days (from 6 hours to 16 days). In cases of patients with blunt injuries the average period of hospitalization was 6.07 +/- 4.26 days, while for the patients with penetrating trauma it was 5.4 +/- 3.36 days. The calculated value oft-student test (0.2766 > 0.05) indicates that there is no statistically significant difference in the period of the hospitalization in relation to the type of trauma (blunt vs. penetrating). The average period of thoracic drainage was 5.58 +/- 3.3 days (from 3 to 17 days). The average duration of thoracic drainage in the patients with blunt trauma was 5.81 +/- 2.67 days, while in the patients with penetrating trauma it was 5.08 +/- 1.99 days. The calculated value of the probability of t-test (0.1478 > 0.05) shows that there is no significant difference in the period of drainage in cases of blunt and penetrating trauma. Out of total number of patients, 98.0% (315/320) of the injured were successfully treated. The complications were found in 1.25% (4/320) cases. Death was the outcome in 1.5% (5/320) of injured. CONCLUSION Based on the results of the initial diagnostic treatment, in majority of injured with isolated thoracic trauma, it was possible to conduct the relevant and appropriate therapeutic procedures. On the basis of relatively short period of thoracic drainage, hospitalization and low rates of morbidity and mortality, it may be confirmed that the application of initial diagnostic and therapeutic protocols of the Clinic for thoracic surgery resulted in the achievement of the successful treatments in majority of the injured for this type of the

The most significant individual prognostic factor for those suffering from NSCLC is cancer invasion of regional lymph nodes, which depends on pathomorphological characteristics of the primary disease. Cellular and histological atopy of the changed tissue means good predispositions for an early lymph invasion and lymphonodular metastasizing. The aim of the paper: a standard statistical analysis which includes frequency of the degree of malignant change differentiation, metastasizing in stages N1 and N2 and the statistical dependence of the mentioned variables. Patients and methods: a retrospective analysis covered 331 patients who underwent a surgical procedure after they had been diagnosed with NSCLC and it was also based on the definite pathohistological postresectional results which included the above mentioned characteristics in a descriptive manner. Results: the average age of the total number of patients was 62.69 ± 7.47. Males were more numerous than females (4.7:1). There was a significant statistic correlation between the development of the disease and the age (ch 2 test = 493.65; p< 0.05), as well as a significant difference of age in relation to gender (p< 0.05). G2 stage of the disease was the most frequent, with participation of 58.00%, and there was a significant statistical correlation between developing the disease and the level of differentiation ( ch 2 test= 248.13; p<0.05). The invasion of the node N1 was 44.61% and of N2 4.53%. There was a statistically significant correlation between N1 and N2 metastases and the level of differentiation of cancer (ch 2 test =24.74; p=0.00 vs. ch 2 test = 16.37; p=0.01). Conclusion: the domination of G2 stage and statistically significant correlation between the levels of differentiation and regional lymphonodular invasion.

INTRODUCTION Hepatic resection is the accepted treatment for various liver tumors. Increasing evidence suggests that two factors significantly influence outcome and successfulness of the hepatic resection in patients with HCC in cirrhosis. There are liver function recovery and the degree of inflammation during early postoperative period. OBJECTIVE Aim of this study was to determine whether probiotic use influences on liver function recovery, degree of inflammation during early postoperative period, intraoperative risk, type and frequency of intraoperative and postoperative complications, morbidity, intraoperative and early postoperative mortality and a one-year survival rate in patients who have been used probiotic, and underwent the hepatic resection due to HCC in cirrhosis. PATIENTS AND METHODS Study was conducted on 120 patients underwent the hepatic resection due to HCC in cirrhosis. This study has been done in University Clinical Centers Tuzla, Maribor and Strasbourg from October 2006 till February 2008. Patients were divided into 2 groups: 1) patients with liver cirrhosis and histologically verified HCC whom underwent liver resection surgery (segmentectomy/ bisegmenctetomy, right and left hemihepatectomy/extended hemihepatectomy) that used preoperatively and postoperatively probiotics (n = 60), 2) a control group of patients with liver cirrhosis and HCC, which did not use preoperative and postoperative probiotics (N = 60). Treatment with probiotics was conducted 3 days preoperatively and postoperatively with 7 day's oral supplementation. RESULTS This study have shown next: patients underwent to the hepatic resection due to HCC in cirrhosis who have been used preoperatively and postoperatively probiotic had liver function recovery better and faster, acute immune response better, serum level of tumor markers lower, intraoperative and postoperative complications were less frequent, and morbidity and mortality rates were lower than in those who have not been using probiotic. CONCLUSION Probiotic use may make liver function recovery better and increases immune response in early postoperative period and positively influences outcome and successfulness of the hepatic resection in patients with HCC in cirrhosis.