Determinants of intention to work abroad of college and specialist nursing graduates in Serbia.

BACKGROUND: In a country with a poor economy and limited job opportunities, the outmigration of students is not commonly perceived as a problem but rather is perceived as a solution to the high unemployment facing young health professionals. OBJECTIVES: Study objectives were to identify the prevalence of intention to work abroad of nursing graduates to point to the predictors of intention to work abroad and predictors of having a firm plan to work in a foreign country. DESIGN: Descriptive study, a survey. SETTINGS: College and specialist nursing schools, Serbia. PARTICIPANTS: 719 nursing graduates from the 2012/2013 school year. METHODS: Voluntarily completed a questionnaire that was designed with regard to similar surveys administered in EU-candidate countries during the pre-accession period. Data were analysed with descriptive and multivariate regression analyses. RESULTS: Almost 70% (501) of respondents indicated an intention to work abroad. Of the nurses, 13% already had established a firm plan to work abroad. Single graduates and those with a friend or relative living abroad were more likely to consider working abroad than were their counterparts (odds ratios were 2.3 and 1.7, respectively). The likelihood of considering working abroad decreased by 29% when the individuals' financial situation was improved. Factors associated with having a firm plan were previous professional experience in a foreign country, having someone abroad and financial improvement (5.4 times, 4.8 times and 2 times greater likelihood, respectively). CONCLUSIONS: The high prevalence of intention to work abroad suggests the need to place the issue of the out-migration of nursing graduates on the policy agenda. College and specialty nursing graduates and health technicians are prepared to work abroad in search of a better quality of life, better working conditions and higher salaries.

Quality of life in patients with multiple sclerosis in Serbia.

OBJECTIVES: The aim of this investigation was to evaluate factors that might influence the health-related quality of life (HRQoL) in multiple sclerosis (MS) patients in Serbia. MATERIALS AND METHODS: This cross-sectional study was performed on a group of 156 patients with MS. HRQoL was assessed by using the SF-36 questionnaire. Expanded Disability Status Scale (EDSS) and Beck Depression Inventory (BDI) scale were assessed as variables affecting the HRQoL of MS patients. RESULTS: EDSS score correlated negatively with all SF-36 health dimensions, and the highest statistically significant coefficients were for physical functioning (r = -0.682), and social and role functioning (r = -0.407 and -0.405 respectively). BDI correlated statistically significantly negatively (P < 0.01) with all SF-36 health dimensions. CONCLUSIONS: Our findings suggest that both disability and depression significantly influence the HRQoL in Serbian MS patients, with depressive symptoms having the major influence.

Anatomical features of perforator blood vessels in the deep inferior epigastric perforator flap.

The anatomical basis of the blood supply to the deep inferior epigastric perforator (DIEP) flap and the circulation of the cutaneous territory zone IV have been studied in 40 anatomical dissections on fresh cadavers. The pedicle length, diameter and the number and distribution of the major perforator vessels were recorded. The cutaneous territories supplied by the perforator vessels were studied by injecting blue dye in the pedicle of ten specimens. In addition, intravital blue dye studies were performed by injecting the largest perforating vessel of five patients at abdominoplasty. The resulting cutaneous staining was recorded. The deep inferior epigastric artery was present in all cadaver dissections with an average length of 10.3 cm (range 9.0-13 cm) and an average diameter of 3.6 mm (range 2.8-5.0 mm). There were consistently one or two major perforator vessels for each pedicle, located within a radius of 8 cm below the umbilicus. The results of the injection study revealed cutaneous staining of zones I-III. Zone IV was stained weakly or not at all. The same findings were obtained in the clinical cases of abdominoplasty. Zone IV must be critically assessed in clinical cases of the DIEP flap.

Thoracic Outlet Syndrome: Follow-up on 33 Cases with Regard to Vascular Compression

This follow-up study on 33 operations performed for thoracic outlet syndrome (TOS) proves high efficiency in relieving neurological and arterial symptoms, whereas benefit to venous compression is somewhat less. Twenty-six patients (average age was 36 years) were operated on for TOS, seven of them on both sides. There was a higher incidence in females. All patients showed neurological symptoms. In 15, operations on various entrapment syndromes of the upper extremity were performed previously. Six patients presented with an incomplete resection of the first rib. Arterial compression symptoms were evident in 15 cases, symptoms of venous compression in 14 limbs. All patients underwent a resection of the first rib, bilateral in seven cases, using the axillary and supraclavicular approach. In seven patients, a cervical rib and scalenus muscles were resected additionally, in three patients bilaterally. In two cases a neurolysis of the brachial plexus was performed. Using the supraclavicular approach, no complications occurred. In one early patient using the transaxillary approach to a postoperative hemothorax required a revision. Neurological results after surgery showed a total release in 26 limbs (n = 33). In 14 limbs (n = 15) with arterial compression symptoms and in 6 (n = 14) with symptoms of venous compression the operation showed a curative effect.

Indication, technique, and results of plantaris medialis neurovascular island flaps.

Treatment of soft tissue defects in the heel often causes problems because of the anatomical structures of the foot and the foot's function in bearing the entire weight of the body. Various types of flap surgery have been tried, to deal with these problem areas. As ever, all the skin flaps lacked the normal quality of the plantar skin, which has fibrous septa with reduced flexibility. In view of the quality of the skin and subcutaneous tissue and the quality of the nerve supply, the technique of neurovascular island flaps for the plantaris medialis was used over the last 4 years in 14 patients, to conceal small to medium-sized heel defects. In this report, we examine anatomy, indication, technique, and results with regard to plantaris medialis island flaps. Their use is discussed in comparison with other types of flaps already used in this region.

Coronary and valvular surgery in elderly patients (greater than 70 years).

During 1949-1964 only 22% of our patients (n = 6807) undergoing cardiac surgery were older than 40 years. Up to 1970 no patients older than 60 years underwent open-heart surgery in our institution. Between 1970 and 1978 an open-heart procedure was performed in 174 patients older than 60 years (4.5%). The hospital mortality was 18.3%. During the following years the operative indication for aged patients became more liberal, and the operative risk decreased distinctly. Already in 1983 the percentage of aged people rose to 24.1% of our extracorporeal circulation group (n = 1111). In a retrospective study (1979 to 1985) a total of 6855 heart procedures using ECC were evaluated. In total 196 patients (2.9%) were 70 years and older. Valvular replacement was performed in 95 cases. (AVR n = 67, MVR n = 13, DVR n = 15) resulting in a hospital mortality of 10.9% (n = 10). Revascularisation for coronary heart disease including resection of ventricular aneurysms was necessary in 64 patients with an early mortality rate of 3.1% (n = 2). The highest risk group consisted of combined coronary and valvular procedures (n = 33) with a mortality rate of 12.1% (n = 4). There was one case each of ASD II, HOCM, left atrial myxoma, and massive pulmonary embolism with cardiogenic shock: only the latter patient died, from cerebral hypoxia postoperatively. Thus the hospital mortality in this age group (n = 196) was 9.1% (n = 17).(ABSTRACT TRUNCATED AT 250 WORDS)