Southeastern European Medical Journal (SEEMEDJ) is the official publication of the Faculty of Medicine, Josip Juraj Strossmayer University Osijek, Croatia
Faculty of Medicine, University Josip Juraj Strossmayer Osijek, Croatia
Learning Intubation with Video-Assisted Optical Devices and with Direct Laryngoscopy - Differences in the Success of Intubation and Learning Curves
Rapid laryngoscopy and intubation are essential for maintaining the airway in the management of patients with impaired consciousness, in patients during induction of anesthesia, and in intensive care units. By examining the patient in advance and using rating scales, it is possible to predict who will have difficulty with laryngoscopy and intubation. Special types of laryngoscopes are among the equipment necessary for difficult airway management. The choice of equipment contributes to successful intubations and fewer attempts. One of the most widely used devices is certainly the video laryngoscope, which comes in different variants. Studies on models in prehospital and hospital settings have shown that video laryngoscopy shortens the time to visualize the vocal cords and increases the success of intubation on the first attempt. The paper briefly describes the most commonly used devices for video-assisted intubation and presents results from studies comparing intubation success with different devices. Keywords: laryngoscopy; intubation, intratracheal; learning curve; video assisted techniques and procedures
video assisted techniques and procedures
Copyright (c) 2026 Varga D, Kvolik S, Palković B. https://creativecommons.org/licenses/by/4.0/
Different Tonsillectomy Techniques: Our Experience
Aim of the study: This study investigates how different tonsillectomy techniques, including the cold steel method, coblation technique, and a device using ultrasonic energy, affect patients’ recovery, specifically pain management. Each technique was compared postoperatively using the visual analogue scale, and the study assessed whether the different techniques increased the risk of revision surgery during the short and long postoperative periods. Methods: Sixty patients were assigned to three groups, with 20 patients in each group (cold steel, coblation, and harmonic ultrasonic scalpel). Patients underwent adenotonsillectomy under general anesthesia using these techniques from November 2024 to July 2025. On the seventh postoperative day, a regular check-up was performed to evaluate pain management using the visual analogue scale. Before surgery, parents of minor children completed the T-14 questionnaire (Throat Disorder Outcome Test), a parent-reported tool used to assess the primary indication for tonsillectomy and adenoidectomy in children. Results: The study included 60 patients, comprising 26 males (43%) and 34 females (57%). Most patients who experienced postoperative hemorrhage had been operated on with the cold steel method, while there was no statistically significant difference in complications between the ultrasound knife and coblation technique. Visual Analogue Scale (VAS) scores were statistically significantly higher among patients operated on with the cold steel method compared to those who underwent coblation or ultrasound knife procedures. Conclusion: Both the harmonic scalpel and coblation techniques for tonsillectomy result in better pain management within the first postoperative week, allowing for an earlier return to everyday activities. Keywords: tonsillectomy, adenoidectomy, pain, tonsillitis, OSA
Copyright (c) 2026 Rezo M, Zubčić Ž, Šestak A, Mendeš T, Abičić I, Prpić T, Bogović V, Milanković SG, Gombarović D, Mihalj H. https://creativecommons.org/licenses/by/4.0/
The Relationship of C-Reactive Protein to Albumin Ratio with Three-Month Survival in Hospitalized Patients with Heart Failure
Aim of the study: This study aimed to investigate the association of the C-reactive protein (CRP) to albumin ratio with three-month survival after hospitalization for heart failure. Methods: Patients hospitalized for heart failure at Department of Cardiology, University Hospital Centre Osijek in the period of 10 months were included. Results: There were 145 patients, of whom 67 (46.2%) were male and 78 (53.8%) female. The median age was 74 years (interquartile range 65–82 years). The most common comorbidities were hypertension (83.4%) and atrial fibrillation (58.6%). Patients treated with mineralocorticoid receptor antagonist (P = 0.02) and furosemide (P = 0.04) had a significantly higher CRP/albumin ratio. A significant positive correlation of CRP/albumin ratio was observed with neutrophil percentage, red cell distribution width, N-terminal pro-B-type natriuretic peptide, and urate concentration, whereas a significant negative correlation of CRP/albumin ratio was observed with diastolic arterial pressure, lymphocyte percentage, haemoglobin, prothrombin time and sodium concentration. Elevated CRP/albumin ratio was associated with higher mortality during the three-month follow-up (P = 0.04). Additionally, higher mortality was observed in patients with chronic obstructive pulmonary disease, a mineralocorticoid receptor antagonist and furosemide in therapy, lower systolic and diastolic blood pressure as well as higher urea, creatinine and urate concentration. Conclusion: The CRP/albumin ratio shows a greater association with the three-month survival of hospitalized patients for heart failure than CRP and albumin individually.
Copyright (c) 2026 Dragila Ž, Maršić L, Mikolčić A, Marušić R, Maričić L. https://creativecommons.org/licenses/by/4.0/
Association between Obesity Severity and Nocturnal Hypoxemia in Obstructive Sleep Apnea
Aim: To evaluate the association between obesity severity and nocturnal hypoxemia in patients with obstructive sleep apnoea (OSA), and to compare the ability of body mass index (BMI) and the apnea–hypopnea index (AHI) to identify nocturnal hypoxemia. Methods: This retrospective cross-sectional study included 70 adult patients diagnosed with OSA who underwent full-night attended polysomnography. Anthropometric data, including BMI and obesity class, and polysomnographic parameters were collected. Nocturnal hypoxemia was defined as peripheral oxygen saturation (SpO₂) < 90%. Associations between nutritional status, nocturnal oxygenation, snoring parameters, and AHI were analysed. Receiver operating characteristic (ROC) analysis was used to assess the discriminatory ability of BMI and AHI for nocturnal hypoxemia. Results: The median age was 58 years (IQR 47–64), and 76% of patients were male. Obesity was present in 74.3% of patients, including 42.3% with class I, 32.7% with class II, and 25.0% with class III obesity. Mean nocturnal oxygen saturation and oxygen saturation nadir declined progressively with increasing obesity class (p = 0.008 and p = 0.02, respectively), whereas AHI showed only a non-significant increasing trend (p = 0.09). Nocturnal hypoxemia was observed predominantly in obese patients and was most frequent in class III obesity (47%, p = 0.04). Both BMI (AUC 0.742) and AHI (AUC 0.805) were significantly associated with nocturnal hypoxemia, with no significant difference between ROC curves (p = 0.41). Conclusion: Obesity severity is strongly associated with nocturnal hypoxemia in OSA, independent of AHI. BMI provides clinically meaningful information comparable to AHI in identifying patients at risk of nocturnal hypoxemia, supporting a complementary approach to OSA severity assessment. Keywords: obstructive sleep apnea; obesity; nocturnal hypoxemia
Copyright (c) 2026 Šarić Jurić J, Osterreicher D, Čubra M, Petek Vinković M, Kralik K, Jurić S. https://creativecommons.org/licenses/by/4.0/
Obstetrics and gynaecology in Croatia stand at an important juncture, characterized by notable clinical achievements alongside emerging demographic, organizational, and scientific challenges. As a country with a long tradition of academic medicine and a publicly funded healthcare system, Croatia has made substantial progress in improving maternal and reproductive health outcomes. At the same time, shifts in population structure, workforce dynamics, and patient expectations require renewed attention to evidence-based practice, innovation, and system-wide collaboration. This special issue of the Southeast European Medical Journal seeks to highlight these themes within a Croatian context, while situating them in the broader regional and European landscape.
Copyright (c) 2025 Southeastern European Medical Journal https://creativecommons.org/licenses/by-nc-nd/4.0
Genetic Polymorphisms and Statin-Associated Side Effects: The Role of SLCO1B1 and Additional Risk Factors
Statins are first-line agents for managing dyslipidemia, primarily prescribed to reduce low-density lipoprotein cholesterol (LDL-C) and prevent atherosclerotic cardiovascular disease (ASCVD). Despite their proven efficacy, there is significant interindividual variability in statin response, with some patients experiencing adverse events such as statin-associated muscle symptoms (SAMS) and hepatotoxicity. These effects are partly attributable to genetic polymorphisms, particularly in the SLCO1B1 gene, which encodes the organic anion-transporting polypeptide 1B1 (OATP1B1) responsible for hepatic statin uptake. The SLCO1B1 rs4149056 polymorphism is associated with impaired transporter function, leading to elevated statin plasma concentrations and a higher risk of statin-induced myopathy, especially with simvastatin. Non-genetic factors, such as hypothyroidism, can exacerbate statin intolerance by impairing lipid metabolism and increasing the risk of myopathy and rhabdomyolysis due to reduced hepatic statin clearance. Vitamin D deficiency has also been linked to increased susceptibility to SAMS, as vitamin D plays a role in muscle function and statin metabolism through CYP enzyme modulation. Coenzyme Q10 (CoQ10) depletion, a consequence of statin therapy due to inhibition of the mevalonate pathway, may further contribute to mitochondrial dysfunction and muscle injury. Incorporating pharmacogenetic testing and addressing modifiable risk factors such as thyroid dysfunction and vitamin D deficiency may optimize statin therapy, reducing adverse effects while maintaining cardiovascular protection. Keywords: hydroxymethylglutaryl-CoA reductase inhibitors; SLCO1B1 gene; hypercholesterolemia; myopathy, statin-induced; pharmacogenomics
hydroxymethylglutaryl-CoA reductase inhibitors
Copyright (c) 2026 Marušić R, Bačun T, Šojat D, Marczi S. https://creativecommons.org/licenses/by/4.0/
Acute Appendicitis: From Pediatrics to Geriatrics
Acute appendicitis is one of the most frequent surgical emergencies. However, its clinical presentation can vary significantly across patient populations. This review summarizes the clinical presentation of acute appendicitis in children, adults, pregnant women, and older adults. While classic symptoms such as abdominal pain that migrates to the right lower quadrant, anorexia, nausea and vomiting are well recognised in the general adult population, they are often absent or altered in children, pregnant women and older adults. In children, symptoms may be nonspecific and and resemble a viral infection, and difficulties in describing pain often contribue to delayd diagnosis and increased risk of perforation. In pregnancy, anatomical displacement of abdominal organs reduce the accuracy of physical examination, complicating decision-making. Older adults commonly present with poorly defined abdominal discomfort, minimal tenderness and reduced inflammatory response due to comorbidities and age-related immune dysfunction, resulting in increased complications and mortality rates. Awareness of these population-specific differences and careful clinical evaluation are essential to prevent diagnostic delays and improve outcomes. Keywords: appendicitis; diagnosis; child; pregnancy; aged
Copyright (c) 2026 Maršić L, Dragila Ž, Mihaljević Z, Nesek Adam V. https://creativecommons.org/licenses/by/4.0/
Impact of a Healthy Work Environment on Retention and Intent to Leave Among Croatian Intensive Care Nurses
Objectives: To identify factors influencing nurse retention in critical care units and examine their relationship with the work environment. Design and Setting: A quantitative cross-sectional study using a self-administered HWEAT survey conducted in 2021/2022 among ICU nurses in Croatia. Methods: The Healthy Work Environment Assessment Tool (HWEAT), developed by the American Association of Critical-Care Nurses (AACN), was used to assess domains of the work environment. The survey also included measures of workplace violence, moral distress, intention to leave, retention factors, and sociodemographic characteristics. Convenience sampling was applied to recruit nurses employed in intensive care units. Results: A total of 277 ICU nurses participated, of which 257 responses were retained after excluding incomplete surveys. The mean age was 32.9 years (SD 9.8), with an average of 9.3 (SD 8.9) years of critical care experience. Overall, 30.4% of nurses reported being delighted with their job and 56% somewhat satisfied, yet 34.2% indicated an intention to leave their position. Nurses who frequently experienced moral distress had a 2.8-fold higher likelihood of intending to leave. Key reasons that would prompt nurses to reconsider leaving included higher salary and benefits (86%), better staffing (78%), and greater opportunities for professional development (75%). The main factors contributing to retention were competitive salaries and benefits, supportive interpersonal relationships, and effective leadership. Conclusion: Approximately one-third of ICU nurses reported an intention to leave their current role. These findings highlight the need for organizational strategies that reduce moral distress, improve staffing, increase salaries, and strengthen supportive and equitable work environments to enhance nurse retention and workforce stability.
Critical care nursing, Nurse Retention, Intention to leave, Work environment
Copyright (c) 2026 Slijepčević J, Režić S, Friganović A, Farčić, N, Georgiou E. https://creativecommons.org/licenses/by/4.0/
Synthesis of Clinical Correlations and Implications of the Kurjak Antenatal Neurodevelopment Test (KANET)
Objectives: The Kurjak Antenatal Neurodevelopmental Test (KANET) is a screening tool designed to identify fetuses at risk for neurodevelopmental disorders by assessing fetal motor and behavioral activity through 4D ultrasound. KANET differentiates between normal, borderline, and abnormal fetal behavior, but it cannot be used to diagnose any specific condition. The objective of this review is to synthesize current evidence on the clinical application of KANET and its effectiveness as a screening tool in assessment of fetal neurodevelopment. Methods: A PubMed search identified 18 relevant studies that evaluated the application of KANET in different maternal risk groups. The studies were analyzed for significant differences in KANET scores between high-risk and low-risk pregnancies. Results: KANET was effective in distinguishing between normal, borderline, and abnormal fetal behavior in high-risk pregnancies, including those complicated by diabetes, hypothyroidism, and abnormal placental flow. However, KANET is not a diagnostic test and cannot confirm the presence of specific neurological disorders in fetuses from high- and low-risk pregnancies. Conclusion: KANET is a valuable screening tool for identifying fetuses at risk for neurodevelopmental problems, but further research is needed to refine its use. Importantly, it is not intended to be used as a standalone diagnostic tool for any specific condition.
Diagnostics and Treatment of Malignant Ovarian Tumors
Malignant ovarian tumors represent a heterogeneous group of neoplasms and a significant clinical challenge. Due to non-specific symptoms in the early stages, they are often diagnosed late, resulting in poor prognosis. Diagnostic evaluation involves a combination of medical history, physical examination, tumor marker assessment, and imaging techniques. Transvaginal ultrasound is the first-line imaging modality, followed by CT, MRI, or PET/CT as needed. Accurate staging is essential for choosing the optimal therapeutic approach. Standard treatment consists of surgery and platinum-based chemotherapy, with PARP inhibitors and anti-angiogenic therapies used in maintenance. In selected young patients, fertility-sparing surgery may be considered. The management of recurrent disease is individualized based on patient characteristics, tumor biology and previous response to therapy.
Diagnostic Accuracy of Atypical Glandular Cells in the Pap Test
Objectives: The focus of this study was to determine how much the new type of categorization “Zagreb 2016.”, that excluded a certain number of glandular findings as reactive and negative, affected the frequency of Pap Test cytological samples marked as atypical glandular lesions (NOS, probably intraepithelial lesion and probably invasive lesion). In addition, we wanted to determine the diagnostic value of category atypical glandular cells (AGC) for each of the three subtypes of this category. Participants and methods: This research included respondents who underwent pathohistological examination of the endometrial or endocervical biopsy tissue sample in Clinical Institute for Pathology Clinical Hospital Center Osijek in time frame from year 2018. to 2022. Respondants previously conducted a cytological examination of the same sample and were marked as atypical glandular cells (AGC). Results: In range from year 2018. to 2022. a decrease in number of patients marked with AGC was noticed. AGC-NOS Pap smear finding has limited diagnostic value for predicting histopathologically confirmed changes. Although there is a significant association, diagnostic concordance is low. In contrast, the AGC – favour invasive lesion category shows high specificity and high positive and negative predictive value. Conclusion: The research showed that using the classification “Zagreb 2016”, which excluded the category atypical glandular cells of undetermined significance, and introduced the category endocervical epithelium reactive and irritated, for epithelium showing only reactive changes, the number of unnecessarily diagnosed and processed patients was reduced. Results of this study confirmed that the diagnostic categories AGC-NOS and AGC – intraepithelial lesion have limited diagnostic value, while the diagnostic category AGC – invasive lesion has significantly better diagnostic features in the prediction of pathohistologically confirmed lesions compared to previous two AGC subgroups
Chronic Pelvic Pain and Endometriosis and Their Impact on Women's Psychological Disorders
Introduction: It is undeniable that chronic pelvic pain, and especially endometriosis, is a growing public health problem. Discussion: Endometriosis is a significant public health problem faced by a very large number of women. There are numerous predisposing factors, and the disease itself has multiple organic and psychogenic aspects that directly affect the quality of life of women. Conclusion: Given the limited effectiveness of surgical and drug interventions in the treatment of chronic pelvic pain and endometriosis, quality diagnostics are necessary. For this reason, the need to introduce targeted biomarkers as well as other minimally invasive diagnostic and therapeutic procedures arises. In this regard, it is of utmost importance to accept the psychological aspects of the disease itself, with an emphasis on their prevention, treatment and monitoring.
Mycosis Fungoides as a Multifaceted Disease – A Case Report
Abstract Introduction: Mycosis fungoides (MF) is a primary cutaneous T-cell lymphoma with a highly variable clinical presentation, while histological findings are often typical. This case report presents an atypical, mimicking manifestation of MF in a 66-year-old patient, whose diagnosis required a multidisciplinary approach. Case presentation: The patient was hospitalized twice at the Department of Dermatology and venerology, University Hospital Centre Osijek, due to a persistent polymorphic rash of changing appearance, localized on the trunk, extremities, face, and the scalp. Considering the atypical clinical course, resistance to topical and systemic therapy, further diagnostic evaluation was required, including immunological, hematological, pulmonary, and infectious disease workup. Multidisciplinary collaboration ultimately led to the establishment of the MF diagnosis. Management and outcome: After failing to respond to topical and systemic corticosteroids, immunomodulators, antibiotics, and hydroxychloroquine, the patient showed a successful therapeutic response to oral methotrexate at a dose of 15 mg once weekly, resulting in complete resolution of skin lesions. Discussion: This clinical case serves as an example of an atypical clinical and histological presentation of MF, along with associated multiple pathological findings, which necessitated the exclusion of several other differential diagnoses. Conclusion: MF can mimic a wide spectrum of benign inflammatory dermatoses, both clinically and histopathologically. Confirming the diagnosis of MF, the so-called “great imitaror”, requires a multidisciplinary approach to both diagnosis and patient management. Keywords: epidermotropism; methotrexate; Mycosis fungoides
Copyright (c) 2026 Žgela M, Lukenda L, Vukšić Polić M. https://creativecommons.org/licenses/by/4.0/
Cervical Adenosarcoma – Case Presentation with Successful Conservative Management
Adenosarcoma is considered one of the rarest malignancies of female genital system accounting for only about 0.2% of all uterine neoplasms. Due to this rare occurrence, there is a limited amount of data relevant to the treatment and observation of this malignant uterine tumour. Although the treatment in this situation is a total hysterectomy and bilateral salpingo-oophorectomy, it is possible to perform a localized tumour excision if the patient wishes to preserve fertility. It is of paramount importance to monitor the patient due to high recurrence of this tumour despite its most common presentation in a localized stage through abnormal uterine bleeding. In this paper, we present a case of a 34-year-old patient who was admitted because of an abnormal uterine bleeding. Ultrasound evaluation confirmed that there was an endocervical polyp. A localized adenosarcoma was histologically confirmed by endocervical polyp ablation. Regular endometrial and endocervical biopsies have not found any tumor cells and the patient spontaneously conceived and successfully delivered two pregnancies. This case is worth presenting because of its rarity and limited amount of existing data and research on the subject.
Laparoscopic Hysterectomy - Perspectives And Alternatives
The advancement of minimally invasive gynecological surgery has significantly impacted the approach to laparoscopic hysterectomy. In 1994, under the leadership of Prof. Kopjar, we performed the first laparoscopic hysterectomy in Southeast Europe, just five years after the world’s first by Prof. Reich. Now, with over a thousand procedures performed and 30 years of experience, we can confidently state that this technique has revolutionized surgical gynecology, challenging long-standing paradigms. As we enter the fourth decade of performing laparoscopic hysterectomies, we can critically assess its benefits. This procedure’s minimal invasiveness has made it a widely accepted option, aligned with proper medical indications. Today, laparoscopic hysterectomy is well-established in clinical practice, and robotic hysterectomy is becoming increasingly prevalent due to its enhanced precision, reduced invasiveness, and faster patient recovery. While its high cost remains a barrier, emerging technologies and more affordable equipment offer hope for broader accessibility. From a public health perspective, laparoscopic hysterectomy offers substantial benefits, including quicker postoperative recovery and a lower rate of complications. These advantages contribute to faster reintegration of patients into the workforce and reduced healthcare burdens. Given that hysterectomy remains one of the most common gynecological surgeries, continued adoption and technological advancement are expected. We are optimistic that the integration of cutting-edge, cost-effective technologies will expand the availability of minimally invasive procedures, ultimately benefiting both individual patients and the broader healthcare system.
minimally invasive gynecological surgery
Work Environment, Job Satisfaction, and Work Ability Among Nurses in Emergency Medical Services: A Pilot Study
Aim: To examine the association between the nursing work environment, job satisfaction, and work ability among emergency medical service nurses. Methods: This pilot cross-sectional study was conducted among nurses working in emergency medical services in two Croatian counties between May and July 2024. Data were collected using a self-administered questionnaire including sociodemographic items and two validated instruments (PES-NWI and WAI). Nonparametric tests, correlation analysis, and bivariate and multivariate logistic regression were applied. Results: Overall, 90 participants (92.8%) had good or excellent work ability (WAI). Staffing and Resource Adequacy differed significantly across work settings (P = 0.002), with lower WAI among dispatch or non-emergency transport staff (median 38.8) compared with Team I (median 43.0) and Team II (median 44.5) (P < 0.001). Work ability was significantly correlated with the nursing practice environment, job satisfaction, and belief in upcoming healthcare reforms, with the strongest association observed between job satisfaction and belief in healthcare improvements (Spearman's rho = 0.725). In multivariate logistic regression, nurses’ participation in hospital work predicted excellent work ability (OR 1.81; 95% CI 1.16–2.83). Conclusion: The findings suggest that characteristics of the nursing work environment are associated with job satisfaction and work ability among emergency care nurses, highlighting the potential importance of supportive leadership, adequate staffing, and opportunities for professional participation. Keywords: emergency nursing, workplace environment, job satisfaction, pilot study
Copyright (c) 2026 Bajan N, Raguž Vinković M, Kralik K, Vukušić M, Bajan A, Matijašić- Bodalec D, Mehičić A, Šolić K. https://creativecommons.org/licenses/by/4.0/
Attitudes and Activities of Primary and Secondary School Pupils and Medical Students in Relation to Social Networks, Sport, Friends and the Use of Mobile Phones
Aim of the study: The aim of the work is to find out what primary and secondary school pupils and medical students think and talk about most often, how they use mobile phones and social networks, and to identify possible interventions that could promote socialising with friends and sporting activities. Methods. The attitudes and behaviours of primary school pupils (N = 51), high school pupils (N = 69), and medical students (N = 108) were compared using a questionnaire on the frequency of activities during the long breaks between lectures. Answers were provided on a 1 to 5 Likert scale. Results. The topic most frequently discussed by all respondents was school (median 4 [IQR 3-5], P = 0.77), while primary school students most frequently discussed and thought about sport (3 [2-4]). High school pupils and medical students discuss and think about food (4[3-4]) and love (4[3-4]) as well. Primary school pupils rarely use social networks (1[1-2]), while high school pupils and medical students use them frequently (4[3-5]) and often search in the networks (4[3-5]) (P<0.001 between primary school pupils and older pupils and students). All respondents believe they should spend more time with friends in person (5[4-5] for all, P = 0.485, ns). Conclusion. Primary school children have the greatest interest in sport and it is at this age that systematic educational programmes should be implemented to encourage participation in sport. Older respondents are more likely to think about having fun. Leisure activities can be a more effective motivator to stimulate their interest in sport and build personal bonds.
Transgenerational Transmission of Trauma
Transgenerational trauma is a term which describes transmission of trauma on next generation, it is defined as relation trauma. It's a proces sin which parents transmiss their own unresolved trauma on their children by specific interactions which results with their children experiencing the trauma without the real experience of trauma. Iti s also called intergenerational, multigenerational trauma. On the next generations transmiss silence or narrativ on traumatic experience. Transgenerational trauma can affect self, affect, cognitive and interperonal functioning. We will present story o fan 17 year old adolescents.
The Concept of Social Support Theory as a Resource in Psychiatric Care
Introduction - An adequate level of social support can significantly improve patients' health status, their health behaviors, and the utilization of health services. Although there are many theories addressing social support, it is essential to analyze and evaluate them before applying them to Croatian nursing practice. Miriam J. Stewart's social support theory can provide substantial assistance to nurses in planning interventions to improve health outcomes. The aim of our research was to analyze and evaluate this theory. Methods - The theory was analyzed and evaluated according to the criteria proposed by McKenna, Pajnkihar, and Murphy. Databases Medline and CINAHL were searched, as well as relevant articles and books available online, using English MeSH keywords: social support, nursing, theory, evaluation, and analysis. Results - A total of 32 articles and three books were analyzed. The social support theory belongs to the middle-range theories in nursing, which deal with structure and interactional relationships. Interactions and relationships with members of social networks can be supportive or unsupportive, thus affecting physical, psychological, and spiritual health and well-being. Social support is a key concept in nursing due to its impact on health and health behavior, and it is suitable for developing empathy and responsiveness to patients' needs. Stewart proposed five main interventions aimed at individuals, dyads, groups, communities, and the social system. Three reliable and valid instruments for measuring social support have been developed. Conclusion - The described theory has great potential for improving nursing practice, but it must first be included in Croatian nursing education so that nurses can acquire the necessary knowledge about nursing theories. The theoretical settings need to be tested in clinical practice.
Exposure of Physicians to Workplace Violence
Introduction: The main goal of the research was to determine whether the doctors who work at the Clinical Medical Center Osijek are exposed to violence in the workplace, in what form of violence, whether there are differences in exposure between doctors according to age, gender and depending on whether they are specialists or residents. Participants and methods: This study is organized as a cross-sectional study. 101 doctors employed at the Clinical Medical Center Osijek participated in this research. The data were collected by answering an anonymous online questionnaire. Results: The majority of respondents who were exposed to violence at the workplace indicated that they had experienced verbal abuse (41.6%), followed by mobbing (21.8%), physical (5%) and sexual abuse (3%). Conclusion: Due to the small sample of the study, there are no significant differences in the distribution of respondents according to exposure to any form of violence in relation to gender, age or whether they are residents or specialists.
“Third wave” Therapies of Behavioral-Cognitive Therapies in the Treatment of Trauma
Techniques from the field of behavioral-cognitive therapy (CBT) have proven to be effective in the treatment of people suffering from post-traumatic stress disorder (PTSD), while in recent times more and more attention has been focused on checking the effectiveness of the so-called third-wave of CBT. Research shows that practicing mindfulness techniques, or focused awareness, can help reduce symptoms of PTSD, such as heightened arousal, recurring night terrors and difficulties with emotional regulation. The effectiveness of these procedures is based on teaching individuals how to focus on the present moment instead of giving in to recurring traumatic thoughts or feelings. In addition, mindfulness can help develop better regulation of emotions and reactions to stressful situations. Also, Acceptance and Commitment Therapy (ACT) techniques have shown promising results in the treatment of trauma. ACT is a form of therapy that focuses on changing the individual's relationship to their thoughts and feelings, rather than changing the content of thoughts and feelings. In the context of PTSD, ACT can help individuals learn to accept traumatic experiences and the feelings that accompany them instead of fighting or repressing them. Acceptance allows people with PTSD to release the feelings of guilt, shame or helplessness that often accompany their reactions to trauma. Additionally, ACT helps individuals identify their values and goals and commit to acting on them, despite the PTSD symptoms they experience. The commitment described can help reduce the avoidance of anxiety-provoking situations or recollections of traumatic events, which can contribute to improving the quality of life of people with PTSD. In conclusion, research confirms the effectiveness of third-wave CBT techniques in the treatment of trauma, but the need for an individualized approach to each patient and the integration of the described techniques into a broader treatment plan that may include other therapeutic modalities depending on the needs of the individual is highlighted.
With the aging population, the prevalence of oncological and other incurable chronic diseases is increasing, which raises the demand for palliative care. Patients in the final stages of illness often experience reduced food and fluid intake, leading to dehydration, while impaired swallowing hinders the oral administration of medications. Traditionally, fluid replacement is performed via intravenous (IV) routes; however, in elderly patients with long-term comorbidities and compromised veins, establishing venous access can be challenging and traumatic. Subcutaneous infusion, also known as hypodermoclysis, represents a simpler and less invasive alternative, especially in palliative care. Hypodermoclysis enables safe and effective administration of fluids and medications into the subcutaneous tissue, reducing the need for repeated venipunctures and minimizing patient discomfort. This method has a long history, first being described in 1865 during a cholera epidemic. Despite its longstanding use, it is still not widely recognized among healthcare professionals. Its advantages include ease of application, lower costs, and the potential for use in home settings, allowing patients to remain in a familiar environment. This study involved a literature search in databases such as PubMed, Scopus, and Web of Science, focusing on research published after 1995. A total of 401 studies, including meta-analysis, review articles, and clinical trials, were analysed to assess the efficacy and applicability of subcutaneous infusion in palliative care. The results indicate that hypodermoclysis is a suitable method for fluid replacement and medication administration, with a lower risk of complications compared to intravenous therapy. Subcutaneous infusion is a safe, effective, and easily applicable method in palliative care. Its wider application can improve the quality of life for patients in the terminal stages of illness, reduce unnecessary medical procedures, and facilitate care in home settings with the active involvement of family members and palliative care teams.
Coronary Angiography Optimized by Optical Coherence Tomography in Patients with Coronary Artery Disease
The aims of the study: The aims of this study were to examine whether there is a difference in the clinical findings of the lesion obtained by coronary angiography and OCT and to examine the association of OCT findings in the decision-making on additional optimization of PCI. Respondents and methods: The research was conducted as a cross-sectional study using historical data. The study included patients who underwent OCT at the Department of Cardiovascular Diseases of the Osijek Clinical Hospital Center from 2021 to 2023. Results: The research involved 62 patients, with a median age of 67. The most common location of the lesion was the LAD, in 52 (84%) cases. Thirty-nine respondents (63%) required additional optimization. Three (5%) patients were recommended for cardiosurgical consultation based on OCT. There was a significant increase in the length of the LAD (Wilcoxon test, P < 0.001), LCx (Wilcoxon test, P < 0.001), and RCA (Wilcoxon test, P = 0.006) as measured by OCT compared to coronary angiography. Regarding proximal width, the values for the LAD (Wilcoxon test, P < 0.001) and RCA (Wilcoxon test, P = 0.03) were significantly higher. Conclusion: The research demonstrated the important role of OCT in clinical practice, particularly in the detailed assessment of coronary artery lesions, management of PCI, and assessment of additional optimization in patients with coronary disease.
Very Early Treatment of Recurrent Strokes with Mechanical Thrombectomy in a Patient with Severe Anemia
Introduction: Recurrent ischemic strokes requiring repeated mechanical thrombectomy (MT) within 24 hours of the initial event are uncommon. This case report describes a 61-year-old woman who underwent two MTs 6 hours apart for ischemic strokes associated with severe anemia due to pure red cell aplasia (PRCA) in different vascular territories. Case Presentation: The patient, with a history of PRCA presented with left-sided hemiparesis and facial paresis. Neuroimaging revealed a right middle cerebral artery (MCA) M1 segment occlusion. She underwent MT with complete recanalization. Four hours later, new neurological symptoms emerged due to a left MCA occlusion, and a second MT was performed successfully. Management and Outcome: Alongside MTs, the patient received supportive care, including blood transfusions, analgesics, and anticoagulants. Her neurological status improved significantly two weeks upon discharge with residual left-sided weakness and facial paresis. At 90 days, the patient was able to walk, indicating further functional improvement. Discussion: This case is notable for the short interval between two MTs and the patient's underlying hematological condition. Severe anemia and PRCA likely contributed to hypercoagulability and increased stroke risk. Despite these unusual risk factors, the patient’s outcome was favorable, which is consistent with the effectiveness of repeated MT for early recurrent ischemic strokes. Conclusion: Early recurrent stroke in different vascular territories, particularly in the context of hematological disorders, is rare but can be managed effectively with timely MT. Further research is needed to evaluate stroke recurrence risk and therapeutic responses in patients with hematological conditions, including PRCA and severe anemia.
Influence of Phacoemulsification on Intraocular Pressure in the Eye after Trabeculectomy
Aim: The aim of this study was to question whether there is a difference in the change of intraocular pressure (IOP) between groups of participants, achieved by phacoemulsification after trabeculectomy, considering the height of IOP at beginning. As well as whether there is a decreased necessity for topical antiglaucoma (ATG) medications. Participants and methods: Study was conducted on 26 participants submitted to cataract surgery after trabeculectomy at the Clinic for Eye Diseases in Osijek (January 2017 - December 2019). IOP values were noted at day zero, seventh day, after a month and six months after patients underwent cataract surgery with phacoemulsification; also, number and type of topical medications. Results: Historic cohort study included 26 patients (19 women, 7 men). Statistically significant decrease of IOP was noticed from day zero and six months after (Friedman's test, P < 0.001). Significant difference was in measured value of IOP at day zero and the first day (Friedman's test, P < 0.05). No statistically significant difference was in participant groups according to IOP (Marginal Homogeneity test, P = 0.06). Conclusion: Trabeculectomy alone and trabeculectomy combined with phacoemulsification, are justified procedures to achieve a decrease in the IOP value and its regulation with subsequent possibility of decrease in usage of local ATG therapy. Phacoemulsification after trabeculectomy ensures an additional decrease of the IOP.
Comparison of Modern Surgical Techniques in a Treatment of Myopia
Aim: To examine whether there is a difference in the outcomes of surgical techniques photorefractive keratectomy (PRK), laser in situ keratomileusis (LASIK) and implantable collamer lens (ICL) for: short-term visual outcome after 6 months, long-term visual outcome after 24 months, procedures safety and remaining refractive error after surgery. Methods: The research was conducted on patients with myopia and myopic astigmatism. Data was collected on the surgical technique performed binocularly: PRK, LASIK or ICL. Visual acuity was measured: before the procedure, 6 months after the procedure and 24 months after the procedure. Data were collected on the occurrence of complications and performed additional corrections. Results: The research was conducted on 150 patients. The median age was 33 years with an interquartile range of 28 to 39 years. The visual outcome was satisfactory in all three groups during two measurement periods after 6 months and after 24 months after procedures. Complications in this study occurred in 13 patients (8,7 %), mostly in LASIK group with total of 11 patients. Suboptimal refractive result that was corrected by additional correction amounts 1,3 % meaning only 2 of patients underwent the correction procedure due to suboptimal refractive error. Conclusion: Short-term and long-term visual outcome after binocularly performed PRK, LASIK and ICL showed success in all groups. ICL and PRK showed the highest safety rate, while LASIK had more frequent complications in this study. A suboptimal refractive result occurred rarely and were additionally corrected if needed.
Retrospective Analysis of Hereditary Thrombophilias Outcomes in Pregnancy – Single Institution Experience
Hereditary thrombophilia introduces a layer of complexity to pregnancy, increasing the risk of serious complications and representing diagnostical and therapeutical challenge. Materials and methods: Retrospective analysis of medical databases from Department of Gynecology and Obstetrics, Institute of Transfusion Medicine and Clinical Department of Pathology and Forensic Medicine, University Hospital Center Osijek consisting of 92 pregnancy cases. Initiation of theraphy with low-molecular-weight heparine started according to evaluation of medical history and genetic risk in I.,II. and III. trimester of pregnancy (33%, 26% and 41%). Data were made from classification of analysed sample (0- as normal value, 1- as unfavorable value, 2- as extremely unfavorable value). Results: According to listed classification in observed sample 75% had normal outcome, 23% had unfavorable outcome and 2% had extremely unfavorable outcome. Analysed placenta was normal in 68%, unfavorable in 21% and extremely unfavorable in 11% of pregnancies. The indication for genetic testing based on positive family history of thromboembolic incidents was set to 31.28% and obstetric history was significant in 58.28% of pregnant women. In 62.42% of pregnant women resulting in normal outcome, 18.49% adverse outcome while 10.98% resulted in miscarriage or fetal death. The likelihood of adverse outcomes of pregnancy is almost the same in the group of pregnant women who received LMWH during pregnancy as in the group without therapy (OR = 1.16, 95% CI 0.59-2.30, P = 0.65). Conclusion: with careful risk assessment, individualized management plans, and close monitoring, the majority of women with these conditions can achieve a successful pregnancy outcome.
Management and Perspectives of Pregnancies in Solid Organ Transplant Recipients
Advances in immunosuppressant drugs and surgical techniques enabled pregnancies in numerous women who suffer of end-stage organ disfunction worldwide. Better tolerance to allogenic grafts, and ameliorated risk of drug toxicity created a possibility of both successful reproduction and preservation of a long-time function of a transplanted organ. 75%of pregnancies in transplant patients are registered among renal transplant recipients, followed by liver and heart transplant, all of them connected into a group of solid organ transplants (SOT). Increasing number of pregnancies emerge also from the group of patients with combined simultaneous renal-pancreatic transplant (RPT), due to treatment of an end-stage organ disfunction of diabetes mellitus Type 1, and a lung transplant, due to terminal stage of cystic fibrosis. All transplant recipints have an increased risk of miscarriage, preterm birth and fetal malformations. Renal and RPT recipients are in enhanced risk of hypertensive disorders and preeclampsia. All the immunosuppressant drugs pass the fetoplacental barrier, and pose a certain risk for embryonal and fetal development. There is no absolute safe immunosuppressant. Pregnancies of women with solid organ transplantations are high-risk pregnancies, with certain peculiarities for each of different transplanted organs. These pregnancies have to be closly monitored and supervised by multidisciplinary teams consisted of transplant medicine specialists, surgeons, maternal-fetal medicine subspecialists and neonatologists. Furthermore, SOT open a new winodow of ethical concerns due to reduced maternal lifespan and different moral dilemmas connected with support of their ofspring.
The Role of Transgenerational Transmission in the Psychological Adjustment of Women with Breast Cancer
Suffering from cancer is a traumatic event for the affected person and can result in a whole series of psychological difficulties, and invasive methods of treatment further deepen them. The previously experienced psychological trauma of a close person can influence the response of a person who is currently experiencing trauma because the far-reaching power of post-traumatic consequences extends through a natural biological barrier far into the next generation (the so-called “transgenerational impact of traumatization”). Sufferers often transfer their fears to their children, changing their responses, with the development of anxiety and depression, especially in traumatic situations (such as when dealing with cancer). Post-traumatic stress disorder (PTSD) in patients who have had a family member with cancer can be reactivated PTSD, developed in the past by living with a close person who was treated for cancer, but it can also manifest itself as a new disorder. By including cancer patients in psychotherapy procedures, we can prevent the development of more severe psychological responses in the second generation, which due to the genetic influence in the inheritance of the disease, will develop cancer and the psychological disorder associated with it, and have a far-reaching effect on strengthening adaptation mechanisms.