Medical education and role of medical informatics.

Bosnia and Herzegovina (BiH), as developing country in transition, has to shift from traditional ways of learning to the transformation of the university education in accordance with Bologna process and educational standards in European Union. In the light of these changes authors conducted research at bio-medical faculties in Sarajevo in order to address issues of the education of future physicians and especially role of medical informatics in their under and post graduate studies and continuous medical education. As per given results in this study, current quality of medical education at biomedical faculties, University of Sarajevo, is unsatisfactory due to several reasons and some among others are those traditionally seen as "computer literacy". Problems are determined and recommendations are given for decision makers to support transformation of BiH medical educational system to have physicians, dentists, pharmacists and nurses who possess the knowledge, skills and attitudes required to be competent in medical informatics if they wish to incorporate into their practices systematic approaches for promoting and maintaining the health of defined populations.

Social networks in improvement of health care.

Social network is a social structure made of individuals or organizations associated with one or more types of interdependence (friendship, common interests, work, knowledge, prestige, etc.) which are the "nodes" of the network. Networks can be organized to exchange information, knowledge or financial assistance under the various interest groups in universities, workplaces and associations of citizens. Today the most popular and widely used networks are based on application of the Internet as the main ICT. Depending on the method of connection, their field of activity and expertise of those who participate in certain networks, the network can be classified into the following groups: a) Social Networks with personal physical connectivity (the citizens' associations, transplant networks, etc.), b) Global social internet network (Facebook, Twitter, Skype), c) specific health internet social network (forums, Health Care Forums, Healthcare Industry Forum), d) The health community internet network of non professionals (DailyStrength, CaringBridge, CarePages, MyFamilyHealth), e) Scientific social internet network (BiomedExperts, ResearchGate, iMedExchange), f) Social internet network which supported professionals (HealthBoards, Spas and Hope Association of Disabled and diabetic Enurgi), g) Scientific medical internet network databases in the system of scientific and technical information (CC, Pubmed/Medline, Excerpta Medica/EMBASE, ISI Web Knowledge, EBSCO, Index Copernicus, Social Science Index, etc.). The information in the network are exchanged in real time and in a way that has until recently been impossible in real life of people in the community. Networks allow tens of thousands of specific groups of people performing a series of social, professional and educational activities in the place of living and housing, place of work or other locations where individuals are. Network provides access to information related to education, health, nutrition, drugs, procedures, etc., which gives a special emphasis on public health aspects of information, especially in the field of medicine and health care. The authors of this paper discuss the role and practical importance of social networks in improving the health and solving of health problems without the physical entrance into the health care system. Social networks have their advantages and disadvantages, benefits and costs, especially when it comes to information which within the network set unprofessional people from unreliable sources, without an adequate selection. The ethical aspect of the norms in this segment is still not adequately regulated, so any sanctions for the unauthorized and malicious use of social networks in private and other purposes in order to obtain personal gain at the expense of individuals or groups (sick or healthy, owners of certain businesses and companies, health organizations and pharmaceutical manufacturers, etc.), for which there is still no global or European codes and standards of conduct. Cyber crime is now one of the mostly present types of crime in modern times, as evidenced by numerous scandals that are happening both globally and locally.

Socio-medical Characteristics of Coronary Disease in Bosnia and Herzegovina and the World.

INTRODUCTION: Coronary heart disease and its etiology are complex socio-medical and clinical problem in this century. World Health Organization defined coronary artery disease as acute and chronic heart ailments due to disruption of flow and myocardial blood supply. Diseases of the cardiovascular system in spite of preventable risk factors are responsible for approximately 50% of all deaths in the developed world, and this ratio is higher in developing countries. RISK FACTORS: CORONARY HEART DISEASE RISK FACTORS CAN BE DIVIDED IN THOSE WHICH ARE NOT PREVENTABLE SUCH AS: personal and family history of cardiovascular diseases, age and gender and preventable risk factors including: high blood pressure, elevated blood cholesterol, smoking, reduced physical activity, elevated blood sugar, increased body weight, alcohol use, psychosocial factors and nutrition. There are also newly emerging risk factors which includes increased homocysteine, thrombogenic and inflammatory factors. Prevention of coronary heart disease risk factors: The concept of risk assessment factors, their reduction, initially begun in the Framingham Heart Study and refined in other models. Primary prevention relates to changing lifestyle and influencing preventable risk factors. Numerous studies and meta-analysis showed that lifestyle modification, risk reduction factors, particularly by changing diet, stopping smoking, increasing physical activity, blood pressure control can be effective in the prevention and reduction of coronary heart disease. Primary health care physicians i.e. family physicians need to take an active role in assessment of risk factors for coronary heart disease. CONCLUSION: The data in this paper, based on the findings from other studies, suggest the importance of using a modified algorithm in order to estimates the overall risk of coronary disease in high-risk groups among the patients in the primary health care settings.

Information Technologies (ITs) in Medical Education.

Advances in medicine in recent decades are in significant correlation with the advances in the information technology. Modern information technologies (IT) have enabled faster, more reliable and comprehensive data collection. These technologies have started to create a large number of irrelevant information, which represents a limiting factor and a real growing gap, between the medical knowledge on one hand, and the ability of doctors to follow its growth on the other. Furthermore, in our environment, the term technology is generally reserved for its technical component. Education means, learning, teaching, or the process of acquiring skills or behavior modification through various exercises. Traditionally, medical education meant the oral, practical and more passive transferring of knowledge and skills from the educators to students and health professionals. For the clinical disciplines, of special importance are the principles, such as, "learning at bedside," aided by the medical literature. In doing so, these techniques enable students to contact with their teachers, and to refer to the appropriate literature. The disadvantage of these educational methods is in the fact, that teachers often do not have enough time. Additionally they are not very convenient to the horizontal and vertical integration of teaching, create weak or almost no self education, as well as, low skill levels and poor integration of education with a real social environment. In this paper authors describe application of modern IT in medical education - their advantages and disadvantages comparing with traditional ways of education.

International public health.

Public health is a broad field that touches several different medical disciplines such as epidemiology, public health informatics, health statistics, environmental protection (ecology), sociology, health promotion, disease prevention and organization of health care for nosological groups of the population. In Europe and the world today is developed a fairly extensive network of scientific and professional institutions engaged in research projects, studies, organization of scientific conferences and publishing scientific and professional articles from the field of public health. Their goal is to promote scientific advances in the field of public health through the exchange of experiences of public-health professionals, training, demonstration of appropriate research models, simulation and application in medical practice.

Nursing information systems.

Computer technology is a reality of our modern world. It gives us a tool which can be used to help us cope with the complexity and efficiency which is often required in many areas of work. It is an erroneous assumption that it robs a situation of its human qualities. No one would deny that the use of a word processor denies the possibility of highly creative writing being produced or that computerized checkouts make the interaction skills of the checkout person irrelevant to the process of struggling with the week's shopping once more. In many ways, the use of the computer frees the person from the drudgery of repetitive labour to allow more time and effort to be available for the more personal skills to find expression. Recording assessment data using a computer keyboard allows just as much caring communication between nurse and clients as writing it down on a form. The critical factor is not the method of recording but the interpersonal skills and motivation of the nurse. The nursing profession is at last beginning to appreciate the role which the new technology can have in improving the service provided to patients. Only by taking an active role now in the implementation of computers to clinical practice can nurses maintain control of their own professional contribution to the large complex systems at present being implemented in many health care settings. Knowledge based systems are set to become a major component in the nurse's ability to take on this role.

Epidemiology features of brucellosis at the Zenica-Doboj Canton area in period 2000-2007.

Area of Zenica Doboj Canton (ZDC), as well as other areas in Bosnia and Herzegovina, due to geographic, climate and agricultural features, also because of the fact, that animal farms and human habitats are closely related, as well as due to the poor hygiene conditions in places with dominant sheep farming, have fruitful conditions for endemic persistence and spreading of brucellosis, as a typical zoonosis. Lack of systematic research about farms that keeping the animals, and Program of control and suppression of brucellosis, as well as other veterinary measures in order to control the health of domestic animals, in order to protect the health of the human population, have the consequence in continuous presence of brucellosis among animals and humans in this area. As the confirmation of this is also the data about the frequency of this disease in the period 2000-2007, is analyzed in this paper. Follow up and control of brucellosis within human population in ZDC during the period observed showed continuous presence of brucellosis with changing morbidity rate and with the tendency for increasing in this period. During observed time period also noticed was the epidemic occurrence of this disease in two municipalities with the largest number and concentration of herds and sheep farms in ZDC (Zenica and Zepce). In total during the epidemic and non epidemic period we registered 294 patients. The number of occasional cases is contained within the total number of cases reported during epidemics.

The advantages and limitations of international classification of diseases, injuries and causes of death from aspect of existing health care system of bosnia and herzegovina.

CONFLICT OF INTEREST: NONE DECLARED. INTRODUCTION: The International classification of diseases (ICD) is the most important classification in medicine. It is used by all medical professionals. CONCEPT: The basic concept of ICD is founded on the standardization of the nomenclature for the names of diseases and their basic systematization in the hierarchically structured category. ADVANTAGES AND DISADVANTAGES: The health care provider institutions such as hospitals are subjects that should facilitate implementation of medical applications that follows the patient medical condition and facts connected with him. The definitive diagnosis that can be coded using ICD can be achieved after several visits of patient and rarely during the first visit. CONCLUSION: The ICD classification is one of the oldest and most important classifications in medicine. In the scope of ICD are all fields of medicine. It is used in statistical purpose and as a coding system in medical databases.

Analysis of the electroencephalogram and pain characteristic in patients before and after carbamazepine treatment.

GOAL OF THE STUDY: To determine the changes of the electroencephalogram and the changes of the quantity in percentage terms of alpha, beta, theta and delta waves in the electroencephalogram in migraine patients after a carbamazepine treatment. Analyze pain characteristics after the carbamazepine treatment of these patients and the efficiency of the carbamazepine treatment in the prevention of new attacks. PATIENTS, METHODS, RESULTS: A retrospective-prospective study has been conducted on 40 persons of approximately 42,9 years of age, with normal cranium CT finding, craniogram and fundus. They were divided in two groups: Group A--21 person who prophylactically took a daily dosage of 400 mg Carbamezepin and during acute pain attacks Naproksen; and group B--19 persons who prophylactically took daily dosage of 400 mg Carbamezepin. EEG test was done twice--before and after the medication, in order to check the concentration of different waves in the EEG in percentages. The T-test doesn't show a statistically significant difference between the alpha (p 0,719), beta 1 (p 0,865), beta 2 (p 0,710), theta (p 0,867) and delta (p 0,272) waves for the group A and for the group B alpha (p 0,996), beta 1 (p 0,920), beta 2 (p 0,826), theta (p 0,324) and delta (p 0,820) waves, on the significance level p 0,05 in the EEG at the beginning and the EEG at the end of the examination. The t-test does show a statistically significant difference between the intensity, frequency, duration and relief of pain at the beginning and at the end of the examination for both test groups. CONCLUSION: Carbamazepin and Paracetamol do not cause changes in the EEG nor in the quantity in percentage terms of concentration of different waves in the control EEG in patients with vascular headaches. Statistically Carbamazepin and Paracetamol significantly change characteristics of pain and can be used for migraine treatment and prophylaxis.

[Criteria how to choose adequate methodology and relevant variables for assessment of quality of primary healthcare]. / Kriteriji za izbor adekvatne metodologije i relevantnih varijabli za procjenu kvaliteta primarne zdravstvene zastite.

INTRODUCTION: Research of satisfaction of patients in the area of primary health care (PHC) and especially criteria how to choose best methodology and the relevant variables guided to the situation where activities were focused on description of the basic structure and processes of health care rather than on identification of needs for services and on result based assessment and satisfaction of patients with provided service. To give advantage to any of methodologies is inexplicable problem and depend of factors beyond of health service control. PURPOSE: Aim of this paper is to review existing measurements of healthcare for ones who intend to use measurements of quality of healthcare for clinical and research purposes and to recommend criteria how to choose adequate methodology and relevant variables for assessment of quality of primary healthcare. METHODOLOGY: For our study we used experience of the Cathedra for Medical Informatics, Medical faculty, University of Sarajevo with emphasis on research of quality of PHC. We selected over 3,000 users of PHC (patients-adults) in PHC units in ten cantons of Federation of Bosnia and Herzegovina. RESULTS: Statistically significant results we got when we crossed general attitude of patients about quality of healthcare with the following variables: place where patient receive healthcare, consultation with patients about patients' rights and life styles. We have not got statistically significant results when we crossed the following variables with general attitude of patients: distance from place of living to place where patients get healthcare, examination schedule in the units of PHC, continuity of healthcare, organization of field service and possibility to choose physician or nurse. CONCLUSION: Very often researchers create their own methods of measurement instead to carry out systematic review of existing ones to enable them to find appropriate one. In this paper we recommended guidelines for finding the most appropriate methods of health measurement using experience of the Cathedra for Medical Informatics, Medical faculty in Sarajevo.

Distance learning at biomedical faculties in bosnia & herzegovina.

Increase and development of distance learning technologies over the past decade has exposed the potential and the efficiency of new technologies. Benefit and use of contemporary information technologies is the area where medical informatics got the most on understanding and importance. Definition of distance learning as "use of technologies based on health care delivered on distance" covers areas such as electronic health, tele-health (e-health), telematics, telemedicine, tele-education, etc. For the need of e-health, telemedicine, tele-education and distance learning there are various technologies and communication systems from standard telephone lines to the system of transmission digitalized signals with modem, optical fiber, satellite links, wireless technologies, etc. Tele-education represents health education on distance, using Information Communication Technologies(ICT), as well as continuous education of a health system beneficiaries and use of electronic libraries, data bases or electronic data with data bases of knowledge. In this paper authors described activities on introduction of distance learning in teaching process at Medical faculty, University of Sarajevo, Bosnia and Herzegovina. Internet was not really meant to be a means of human communication at first; but the clearly the Net become a main piece of human communication.

Family Registration Card as electronic medical carrier in Bosnia and Herzegovina.

Medical documentation is a very important part of the medical documentalistics and is occupies a large part of daily work of medical staff working in Primary Health Care. Paper documentation is going to be replaced by electronic cards in Bosnia and Herzegovina and a new Health Care System is under development, based on an Electronic Family Registration Card. Developed countries proceeded from the manual and semiautomatic method of medical data processing to the new method of entering, storage, transferring, searching and protecting data, using electronic equipment. Currently, many European countries have developed a Medical Card Based Electronic Information System. Three types of electronic card are currently in use: a Hybrid Card, a Smart Card and a Laser Card. The dilemma is which card should be used as a data carrier. The Electronic Family Registration Cared is a question of strategic interest for B&H, but also a great investment. We should avoid the errors of other countries that have been developing card-based system. In this article we present all mentioned cards and compare advantages and disadvantages of different technologies.

[Electronic data records in primary health care and aspects of their development in Bosnia and Herzegovina]. / Elektronski nosaci podataka u primarnoj zdravstvenoj zastiti i razvojne perspektive u BiH.

In Medical Informatics medical documentation and evidention are most probably the key areas. Also, in primary health care it is very important and part of daily activity of medical staff. Bosnia and Herzegovina is trying to be close to developed countries and to modernize and computerize current systems of documentation and to cross over from manual and semi manual methods to computerized medical data analysis. The most of European countries have developed standards and classification systems in primary health care for collecting, examination, analysis and interpretation of medical data assessed. One of possibilities as well as dilemma, which data carrier should be used for storage and manipulation of patient data in primary health care, is use of electronic medical record. Most of the South East European countries use chip or smart card and some of countries in neighborhood (Italy) choose laser card as patient data carrier. Both technologies have the advantages and disadvantages what was comprehensively colaborated by the authors in this paper, with intention to help experts who make decisions in this segment to create and to correctly influence on improvement of quality, correctness and accuracy of medical documentation in primary health care.