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PALLIATIVE CARE ON THE ISLAND OF RAB; CHALLENGES AND EXPERIENCES OF FAMILIES IN PROVIDING SUPPORT TO PATIENTS
No full textIstraživanje provedeno na otoku Rabu istražuje iskustva i izazove s kojima se obitelji suočavaju
prilikom pružanja palijativne skrbi. Glavni fokus istraživanja bio je na emocionalnoj podršci,
komunikaciji i organizaciji skrbi. Rezultati ukazuju na važnost stručne pomoći koju obitelji
često navode kao potrebnu, uključujući emocionalnu, psihološku, medicinsku i duhovnu
podršku. Potvrđeno je postojanje značajnih emocionalnih izazova, poput stresa, tuge i
iscrpljenosti, koji upućuju na potrebu za sustavnom emocionalnom podrškom. Financijski i
medicinski problemi, kao i nedostatak resursa, bili su dodatni izazovi s kojima su se obitelji
suočavale. U analizi iskustava obitelji s palijativnom skrbi na Odjelu za produženo liječenje i
palijativnu skrb Županijske specijalne bolnice Insula Rab, većina ispitanika iskazala je visoko
povjerenje u ustanovu i zadovoljstvo kvalitetom skrbi, uz prepoznavanje pozitivnih aspekata
poput sigurnosti, edukacije i komunikacije sa zdravstvenim timom. Iako su rezultati bili
pretežito pozitivni, postoji i prostor za poboljšanja, posebno u složenim situacijama.
Istraživanje naglašava važnost integracije sustava podrške za obiteljske skrbnike, uključujući
dostupnost stručnjaka, edukaciju, te emocionalnu i psihološku podršku, kako bi se unaprijedila
kvaliteta palijativne skrbi u zajednici.The research conducted on the island of Rab explores the experiences and challenges faced by
families when providing palliative care. The main focus of the research was on emotional
support, communication, and care organization. The results highlight the importance of
professional assistance, which families often identify as necessary, including emotional,
psychological, medical, and spiritual support. Significant emotional challenges, such as stress,
grief, and exhaustion, were confirmed, indicating the need for systematic emotional support.
Financial and medical issues, along with a lack of resources, were additional challenges faced
by families. In the analysis of families' experiences with palliative care at the Department of
Extended Care and Palliative Care of the County Special Hospital Insula Rab, most respondents
expressed high trust in the institution and satisfaction with the quality of care, recognizing
positive aspects such as safety, education, and communication with the healthcare team.
Although the results were predominantly positive, there is room for improvement, especially
in complex situations. The research emphasizes the importance of integrating a support system
for family caregivers, including the availability of professionals, education, and emotional and
psychological support, to improve the quality of palliative care in the community
Content and evaluation od prenatal education in Primorsko-goranska county
No full textTečajevi za trudnice ključni su dio pripreme za porođaj i roditeljstvo, pružajući trudnicama i njihovim partnerima informacije o trudnoći, porođaju, dojenju, babinju i psihološkim aspektima roditeljstva. Cilj istraživanja uključuje evaluaciju kvalitete trudničkih tečajeva u Primorsko-goranskoj županiji prema njihovoj usklađenosti sa smjernicama UNICEF-a te analizu zastupljenosti primalja u odnosu na druge profesije. Istraživanje se temelji na analizi programa, trajanja i strukture tečajeva provedenih u razdoblju od 2018. do 2022. godine u deset domova zdravlja, Kliničkom bolničkom centru (KBC) Rijeka, Poliklinici Finderle i Centru za perinatalnu psihologiju i rano roditeljstvo. Rezultati su pokazali razlike u podudarnosti tema sa smjernicama UNICEF-a među ustanovama, pri čemu Centar za perinatalnu psihologiju i rano roditeljstvo ima najveći postotak (70%) dok Dom zdravlja Mali Lošinj ima najmanji postotak (30%). Trajanje tečajeva pokazuje značajna odstupanja od smjernica, tako Dom zdravlja Čavle ima najveću podudarnost u trajanju tečaja (70,59%), a KBC Rijeka ima najmanju podudarnost (32,35%). Također, primijećena je i niža zastupljenost primalja među predavačima (4% bacc.obs., 2% mag.obs.), što ukazuje na potrebu za većom integracijom primalja u edukacijske programe. Zbog pandemije COVID-19, mnogi su se tečajevi prilagodili online formatima čime su sami tečajevi postali dostupniji, ali su imali izazove u pogledu interaktivnosti i praktičnih vježbi. Iako se trudnički tečajevi svakodnevno nastavljaju razvijati, ovo istraživanje ukazuje na potrebu za standardizacijom programa i većim uključivanjem primalja kako bi se osigurala kvalitetnija priprema trudnica za porođaj i roditeljstvo.Prenatal education is a key part of preparation for childbirth and parenting, providing pregnant women and their partners with information on pregnancy, childbirth, breastfeeding, postpartum care, and the psychological aspects of parenting. The aim of the research includes evaluating the quality of prenatal education in the Primorsko-goranska County according to their compliance with UNICEF guidelines and analyzing the representation of midwives compared to other professions. The research is based on an analysis of the programs, duration, and structure of classes conducted from 2018 to 2022 in ten health care centers, the Clinical Hospital Center Rijeka (KBC Rijeka), the Finderle Polyclinic, and the Center for Perinatal Psychology and Early Parenthood. The results revealed differences in the alignment of topics with UNICEF guidelines among institutions, with the Center for Perinatal Psychology and Early Parenthood achieving the highest compliance rate (70%), while the Mali Lošinj Health Center had the lowest rate (30%). The duration of classes showed significant deviations from the guidelines, with Čavle Health Center having the highest alignment in duration (70.59%) and KBC Rijeka the lowest (32.35%). A lower representation of midwives among instructors (4% bacc.obs., 2% mag.obs.) was also noted, indicating the need for greater integration of midwives into educational programs. Due to the COVID-19 pandemic, many classes transitioned to online formats, increasing accessibility but posing challenges in interactivity and practical exercises. Although antenatal education continue to evolve daily, this research highlights the need for program standardization and greater involvement of midwives to ensure better preparation for childbirth and parenting
KNOWLEDGE OF STUDENTS ON CARE OF PATIENTS WITH LIMB AMPUTATION : FINAL THESIS
No full textOvo istraživanje imalo je za cilj ispitati razinu znanja studenata sestrinstva o zbrinjavanju pacijenata s amputacijom ekstremiteta te identificirati izvore iz kojih su studenti stjecali znanje. Rezultati pokazuju da studenti sestrinstva posjeduju relativno dobro znanje o ovoj temi, s prosjekom točnih odgovora od 76%, čime se potvrđuje da studenti točno odgovaraju na više od 60% pitanja. Pokazalo se da studenti treće godine imaju značajno veće znanje u usporedbi s prvom i drugom godinom, što naglašava važnost specijaliziranih kolegija u obrazovanju. Studenti su najviše znanja stekli kroz kolegije "Kirurgija, traumatologija i ortopedija" te "Zdravstvena njega odraslih II", koji su se pokazali ključnima za razvoj kompetencija. Većina ispitanika izrazila je potrebu za više kliničkih vježbi kao načina za unapređenje znanja i vještina. Ograničenja istraživanja uključuju korištenje prigodnog uzorka te prikupljanje podataka putem online anketa, što može utjecati na generalizaciju rezultata. Potrebna su dodatna istraživanja kako bi se osiguralo bolje razumijevanje praktičnih kompetencija studenata u kliničkom okruženju.The aim of this study was to examine the level of knowledge of nursing students regarding the care of patients with limb amputation and to identify the sources from which students acquired this knowledge. The results indicate that nursing students possess relatively good knowledge on this topic, with an average correct response rate of 76%, confirming that students correctly answer more than 60% of the questions. It was found that third-year students have significantly higher knowledge compared to first- and second-year students, highlighting the importance of specialized courses in education. Students acquired most of their knowledge through courses such as "Surgery, Traumatology, and Orthopedics" and "Adult Health Care II," which proved crucial for developing competencies. The majority of respondents expressed the need for more clinical exercises as a way to improve their knowledge and skills. Limitations of the study include the use of a convenience sample and data collection via online surveys, which may affect the generalizability of the results. Further research is needed to better understand students' practical competencies in a clinical environment
Humane restraint of patients in the acute wards of Psychiatric hospital Ugljan
No full textU ovom radu osvrnut ćemo se na formalne metode prisile i njihovu učestalost u Psihijatrijskoj bolnici Ugljan, na ženskom i muškom akutnom odjelu. Cilj rada je istražiti duljinu, razloge te učestalost humanog sputavanja na akutnim odjelima Psihijatrijske bolnice Ugljan.In this paper, we will look at the formal methods of coercion and their frequency in the Ugljan Psychiatric Hospital, in the women's and men's acute wards. The aim of this paper is to investigate the length, reasons and frequency of humane restraint in the acute wards of the Ugljan Psychiatric Hospital
Disease Characteristics and Treatment Outcomes of Myeloma Patients Under 50 Years of Age: An Analysis of the Balkan Myeloma Study Group
No full textYounger multiple myeloma (MM) patients, representing 10% of cases, show distinct clinical features, including lower anemia and renal impairment rates but higher lytic bone disease and adverse cytogenetics. Retrospective analysis reveals better complete response and survival outcomes, with median OS exceeding 15 years. Key prognostic factors include anemia and high-risk cytogenetics, while autologous stem cell transplantation significantly improves outcomes, highlighting the importance of tailored, intensive treatment strategies. Background: Multiple myeloma (MM) is predominantly a disease of the elderly, but approximately 10% of patients are younger than 50 years at diagnosis. Methods: This study aimed to investigate the clinical characteristics, treatment outcomes, and prognostic factors in younger MM patients using retrospective data from the Balkan Myeloma Study Group registry. Results: A total of 350 patients under 50 years old were included, comprising 10.4% of the overall cohort. The study found that younger patients had lower rates of renal impairment and anemia but a higher incidence of lytic bone disease and adverse cytogenetics. Treatment regimens, including proteasome inhibitors and immunomodulatory agents, were comparable between younger and older patients, but younger patients had significantly better complete response rates and overall survival (OS). The 5- and 10-year OS rates were 76% and 64%, respectively, with a projected median OS exceeding 15 years. Factors such as anemia, hypercalcemia, and high-risk cytogenetics were associated with worse survival outcomes. Autologous stem cell transplantation (ASCT) emerged as a key contributo
Critical care nurses’ intention to leave and related factors: Survey results from 5 European countries
No full textObjectives: To determine the nursing intention to leave in critical care units and explore related factors along with work environment and sociodemographic variables.
Design and setting: Quantitative cross-sectional study in five European countries (Spain, Poland, Croatia, Cyprus and Romania) through a self-administered survey in 2021.
Methods: The "AACN Critical elements of a healthy work environment scale. National Survey of Critical-Care Nurse Work Environments" by the American Association of Critical Care Nurses was distributed to all nurses working in intensive care units through a convenience sampling method. The questionnaire included questions about healthy work environment, burnout, violence, intention to leave and sociodemographics.
Results: 1033 responses were analysed. Participants from each country varied between 75 and 275 nurses. Mean age was 37.3 years old (SD 9.9) with a mean nursing experience in critical care of 10.8 (9.2) years. Despite 83.1 % of the nurses were satisfied with their current job, 22.8 % planned to leave their position. Intention to leave was independently associated with the country, gender, age, satisfaction with current job and frequency of moral distress (p < 0.05) along with several work-related variables, such as lower perception of a healthy work environment. Among the reasons to reconsider leaving the job, the most rated were higher salary and benefits (87.2 %), better staffing (85.3 %) and meaningful recognition (82 %). Conversely, the most relevant reasons that kept nurses working in their organisation, were salary and benefits and the people they work with.
Conclusion: Almost one out of three critical care nurses are considering leaving their job. Many aspects of the work environment that influence the intention to leave are modifiable.
Implications for clinical practice: Managers need to prioritise the retention of registered nurses, not only recruiting new personnel. Many aspects of the working environment need to be addressed in other to retain critical care nurses
The role of radiological techniques in the diagnosis of thyroid diseases
No full textŠtitna žlijezda ima važnu ulogu u regulaciji brojnih fizioloških procesa u ljudskom organizmu, a poremećaji njezine funkcije sve su češći u suvremenom društvu. Pravovremena i točna dijagnoza bolesti štitne žlijezde ključna je za uspješno liječenje, a u tom procesu radiološke metode zauzimaju posebno mjesto. Cilj ovog rada bio je prikazati ulogu i značaj različitih radioloških tehnika u dijagnostici bolesti štitne žlijezde, s naglaskom na njihovu kliničku primjenu, prednosti i ograničenja. Kroz teorijski dio objašnjeni su anatomija i fiziologija štitne žlijezde, najčešći poremećaji i klinička slika. U nastavku rada detaljno su opisane radiološke metode koje se primjenjuju u dijagnostici – ultrazvuk (UZV), scintigrafija, računalna tomografija (CT), magnetska rezonancija (MR) i pozitronska emisijska tomografija (PET/CT). Svaka od ovih metoda donosi specifične informacije koje su važne za postavljanje dijagnoze i praćenje bolesti. Rad također uključuje usporedbu navedenih metoda s obzirom na njihovu dijagnostičku točnost, primjenu u kliničkoj praksi i mogućnosti kombinacije više tehnika radi postizanja što preciznijeg uvida u stanje štitne žlijezde. Zaključeno je da je individualizirani, multimodalni pristup najdjelotvorniji za uspješnu dijagnostiku i liječenje bolesti ovog važnog endokrinog organa.The thyroid gland plays a crucial role in regulating numerous physiological processes in the human body, and disorders of its function are becoming increasingly common in modern society. Timely and accurate diagnosis of thyroid diseases is essential for effective treatment, and radiological techniques play a central role in this process. The aim of this paper was to present the role and importance of various radiological methods in the diagnosis of thyroid diseases, with an emphasis on their clinical application, advantages, and limitations. The theoretical section explains the anatomy and physiology of the thyroid gland, the most common disorders, and their clinical presentation. The paper then provides a detailed description of radiological techniques used in diagnostics—ultrasound (US), scintigraphy, computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography combined with CT (PET/CT). Each of these methods provides specific information that is essential for diagnosis and disease monitoring. The paper also includes a comparison of these methods in terms of their diagnostic accuracy, clinical application, and the potential for combining multiple techniques to achieve the most accurate assessment of the thyroid gland. It is concluded that an individualized, multimodal approach is the most effective for the successful diagnosis and treatment of disorders of this important endocrine organ
Uloga hitnog medicinskog transporta u zbrinjavanju infarkta miokarda sa ST elevacijom
No full textCilj: Ishemijska bolest srca, uključujući infarkt miokarda s elevacijom ST segmenta (STEMI.engl. ST elevation myocardial infarction), predstavlja vodeći uzrok prerane smrti u svijetu, pa tako i u Hrvatskoj. Hitna uspostava protoka krvi u zahvaćenoj koronarnoj arteriji temelj je liječenja, a ključni element u postizanju toga cilja je hitan medicinski transport bolesnika do najbližeg centra za invazivnu kardiologiju. Stoga je cilj ovoga istraživanja bio utvrditi osnovne demografske i epidemiološke odlike bolesnika sa STEMI podvrgnutih hitnoj intervenciji timova Zavoda za hitnu medicinu (ZZHM) Zadarske županije.
Bolesnici i metode: Proveli smo retrospektivnu analizu podataka iz medicinske dokumentacije u pismohrani ZZHM Zadarske županije, koja je obuhvatila 820 bolesnika s dijagnozom STEMI, transportiranih vozilom ZZHM u razdoblju od 01.06.2015. do 31.12.2023. godine. Analizirali smo dob i spol bolesnika, temeljne vitalne parametre (krvni tlak, frekvencija bila i zasićenost periferne krvi kisikom), vrijeme proteklo od poziva do dolaska bolesnika u bolnicu i podatke o preživljavanju bolesnika. U ovom istraživanju koristili smo program Statistica verzija 14.1.0.8 (Cloud Software Inc.). Za opis podataka koristili smo deskriptivnu statistiku, Kolmogorov-Smirnovljev test i neparametrijske testove. Vremenski niz analizirali smo korištenjem linearnog trenda. Statističku značajnost procijenili smo na razini p≤0,05, uz 95%-tne granice pouzdanosti.
Rezultati: Utvrdili smo kako se STEMI češće javlja kod muškaraca, posebice poslije 50-te godine života. Žene s dijagnozom STEMI starije su od muškaraca (73 u odnosu na 65 godina). U ispitivanom razdoblju bilježi se kontinuirani porast broja transporta zbog STEMI od oko 10%. Unatoč tome, vrijeme proteklo od poziva do izlaska na teren je u 50,86% slučajeva manje od 10 minuta, a 97% prijevoza obavljeno je unutar 120 minuta. Stopa preživljenja u ispitivanom razdoblju iznosila je 99,27%.
Zaključak: Kontinuirani porast broja transporta bolesnika sa STEMI ukazuje na nužnost daljnjeg strateškog planiranja i razvoja organizacije Zavoda za hitnu medicinu Zadarske županije, kao i na potrebu za jačanjem javnozdravstvenih preventivnih aktivnosti. Većina bolesnika transportirana je u bolnicu u zadovoljavajućim vremenskim okvirima, uz visoku stopu preživljenja
Impact of Oral Exam Stress on Physiological Parameters in Students: Insights from Smart Bracelet Monitoring - A Pilot Study
No full textIntroduction: Stress is an essential element of students' academic lives, especially
as exams approach. Due to academic demands, social pressure, and personal expectations,
stress can negatively impact students' mental and physical health and lead to an increased
risk of chronic illness. This study investigated the effects of oral exams on students' physiological
parameters.
Material and Methods: The study involved 35 physiotherapy students. The "Smart Bracelet
TK 30" monitored heart rate, blood pressure, and blood glucose levels before and during the
exams.
Results: Significant blood pressure and pulse changes were observed between resting and
exam conditions. Blood glucose levels were higher in men than in women during the exams.
Conclusion: Exam stress significantly impacts students' physiological responses. Given the
potential long-term health risks, preventive health strategies should be developed to help students
cope with academic stress
Stavovi učitelja prema inkluzivnom obrazovanju mjereni MATIES skalom
No full textInclusive education is a complex concept that involves the interplay of practice, culture, and policy, all of which shape inclusive practices through intricate interrelationships. Teachers, as the promoters of inclusive education, play a crucial role. Attitudes are a complex construct consisting of three components(cognitive, affective, and behavioral). Since attitudes are tendencies that can guide behavior, teachersare more likely to implement inclusive practices if they have positive attitudes. The research aimed to de-termine the metric characteristics and construct validity of the MATIES multidimensional scale on teachers’ attitudes towards inclusive education (IE) and to explore how teachers at primary schools in Croatia evaluate each of the three components of their attitudes towards IE. The study was conducted between May 1 and July 30, 2024, as a cross-sectional study of a probabilistic sample of 478 primary school teachers across Croatia (F = 445, M = 33) via an online questionnaire using the multidimensional MATIES scale. A four-point Likert scale was used, with descriptive indicators and t-tests set at 2.5 for a neutral stance. Confirmatory factor analysis confirmed the construct validity of the MATIES questionnaire. All three subscales showed high internal reliability. Teachers’ attitudes were generally positive (M = 2.60), and all three components of the attitude were also positively assessed: the cognitive component (M =2.60), the affective component (M = 2.96), and the behavioral component (M = 3.23). The behavioral component of attitude accounted for the largest percentage of variance, with 38.65%, followed by the affective component with 12.53% and the cognitive component with 9.65%. The translated and validated MATIES questionnaire exhibits satisfactory psychometric characteristics and is a reliable instrument that can be utilized in further research in its current form. The finding that teachers have positive attitudes toward inclusion should encourage inclusive policymakers to provide additional support to teachers in order to maintain teachersʼ positive attitudes.Inkluzivno obrazovanje složen je koncept koji obuhvaća međudjelovanje prakse, kulture i politike koji pak oblikuju inkluzivnu praksu u složenim međuodnosima. Učitelji kao promotori inkluzivnoga obrazovanja imaju ključnu ulogu. Stavovi su složen konstrukt koji se sastoji od tri komponente (kognitivne, afektivne i bihevioralne), a kako su stavovi tendencije koje mogu usmjeravati ponašanje, učitelji će vjerojatnije provoditi inkluzivne prakse ako imaju pozitivne stavove. Cilj istraživanja bio je utvrditi metrijske karakteristike i konstruktnu valjanost višedimenzionalne MATIES skale o stavovima učitelja prema inkluzivnom obrazovanju (IE), a zatim istražiti kako učitelji u osnovnim školama u Hrvatskoj procjenjuju svaku od tri komponente stava prema obrazovanju. Istraživanje je provedeno između 1. svibnja i 30. srpnja 2024. kao presječna studija na probabilističkom uzorku od 478 učitelja osnovnih škola diljem Hrvatske (F = 445, M= 33), i to online upitnikom korištenjem višedimenzionalne MATIES skale. Korištena je Likertova skala s četiri stupnja, s deskriptivnim indikatorima i t-testovima postavljenima na 2,5 za neutralan stav. Konfirmatorna faktorska analiza potvrdila je konstruktnu valjanost MATIES upitnika. Sve tri podskale pokazale su visoku unutarnju pouzdanost. Stavovi učitelja bili su općenito pozitivni (M = 2,60) i sve tri komponente stava također su pozitivno ocijenjene: kognitivna komponenta (M = 2,60), afektivna komponenta (M = 2,96) i bihevioralna komponenta (M = 3,23). Bihevioralna komponenta stava objasnila je najveći postotak varijance s 38,65 %, zatim afektivna komponenta s 12,53 % i kognitivna komponenta s 9,65 %. Prevedeni i validirani MATIES upitnik ima zadovoljavajuće psihometrijske karakteristike i pouzdan je instrument koji se u ovom obliku može koristiti u daljnjim istraživanjima. Nalaz da učitelji imaju pozitivne stavove prema inkluziji trebao bi potaknuti kreatore inkluzivnih politika da dodatno podrže učitelje u cilju očuvanja pozitivnih stavova učitelja