Foreknowledge of the Fourth Semester Students about Medical Informatics at the Medical Faculty University of Sarajevo.

INTRODUCTION: High educational and teaching standards were the main reason why from the begging student satisfaction surveys and assessments of the students' knowledge, attitudes and opinions were paramount in the educational process at the Cathedra for Medical Informatics at the Medical Faculty University of Sarajevo. AIM: The aim of this study was to evaluate general knowledge of the fourth semester students about informatics and medical informatics and compare it with previous generations. METHODS: Students at the beginning of the fourth semester and before second planned lectures receive "Questionnaire for biomedical students about use and knowledge of information technologies". Collected data was retrospectively used for this study. The scientific study committee of the Cathedra for Medical Informatics reviewed and approved the database for using this study. At the beginning of the survey, all students were informed that their data could be tracked. Also, all students were informed and got lectures on surveys, development and use of questionnaires for the examination of the patient/student satisfactions and how results of the survey and analysis could help continuously improving quality of the teaching process. DISCUSSION AND CONCLUSION: Medical students come to the faculty with significant IT knowledge and skills. It can even be argued that students rank their knowledge in some way lower than we as teachers estimate based on their practical work. They organize groups on social networks where they exchange information about lectures and exams. It is common for each study year to have its own group. Through this group, information and presentations that teachers send to students are exchanged. One of the goals of teaching medical informatics is the method of searching for medical information on the Internet. The skills learned in medical informatics classes complement those learned earlier and provide a solid base for physicians who are able to supplement their knowledge using IT technologies when they need it.

Elective Case Cancellation on the Day of Surgery at a General Hospital in Sarajevo: Causes and Possible Solutions.

INTRODUCTION: Cancelling elective procedures on the day of surgery presents a constant problem in all higher-level medical facilities, and the research of causes, consequences and possible solutions is the duty of every facility in order to enhance the quality of healthcare services. AIM: The aim of the research was to determine the percentage and reasons for cancelling elective procedures and provide adequate measure to reduce this number in the future and to identify ways to improve the patients' satisfaction level. MATERIAL AND METHODS: This prospective study included all patients that were scheduled for surgery from March 2016 to November 2018 in the operating rooms at our Department of Surgery, including both performed and cancelled cases. Cases by different surgical departments (general surgery, gynecology, orthopedics, urology, plastic surgery, ophthalmology and otorhinolaryngology) were all included. RESULTS: Out of 8201 planned elective procedures from March 2016 to November 2018 at the General Hospital "Abdulah Nakas", 7825 cases were performed and 376 cases (4.58%) were cancelled on the day of surgery. The most common reasons for cancelling a surgical procedure on the day of surgery were: lack of time to perform surgery (33.51%), surgery cancelled due to medical/anesthetic reasons (31.38%), surgical procedure cancelled by the surgeon on the day of surgery (11.97%). CONCLUSION: This study has shown that the percentage of elective cases cancelled on the day of surgery at our institution stands at an acceptable 4.58%. The most common reasons for case cancellation on the day of surgery were identified. The majority of reasons for cancellation were avoidable, which means that appropriate steps could contribute to lowering the percentage of cancelled elective cases and an improved quality of healthcare services.

Effect of Local Anesthesia on the Postoperative Pain After Laparoscopic Appendectomy.

BACKGROUND: Laparoscopic surgery causes less pain than traditional surgery; however, to relieve postoperative pain, surgeons frequently apply local anesthetic preemptively. The aim of this study was to assess the effect of different local anesthetics on pain intensity in patients who had undergone a laparoscopic appendectomy (LA), who received the anesthetic preemptively at incision sites and postemptively, intraperitoneally and trocar sites. PATIENTS AND METHODS: A total of 120 LA patients (men and women) were randomly assigned to 1 of the 4 groups (N = 30/group): Group 1: no peritoneal or local administration of local anesthetics during LA; Group 2: 5 mL of 1% lidocaine was applied at incision sites and 10 mL 1% lidocaine was injected under direct vision in the right iliac fossa area and around the stump of the appendix and trocar sites at the end of the procedure; Group 3: 5 mL of 0.5% levobupivacaine applied at incision sites +10 mL 0.5% levobupivacaine injected in the same place intraperitoneally and trocar sites at the end of the procedure; Group 4: 5 mL of 0.5% ropivacaine at incision sites +10 mL 0.5% ropivacaine injected in the same place intraperitoneally and trocar sites at the end of the procedure. Postoperative pain was assessed after 2, 6, 24, and 48 hours using a visual analogue scale (VAS). RESULTS: By comparing the average values of pain intensity using VAS, we observed significantly different average values of pain intensity in the levobupivacaine and ropivacaine (3 and 4) groups in comparison with the control Group 1 (P < .05) throughout the follow-up period. CONCLUSION: We observed a reduction in postoperative pain, nausea, and vomiting in patients with LA who received intraoperative local anesthetic preemptively at the incision sites and postemptively, intraperitoneally. After the application of levobupivacaine the intensity of pain was significantly lower than in any other tested group.

Efficiency of Local Antiseptic Alkosol (Ethanol, Isopropanol-30g and Ortophenilphenol) and Povidone Iodide on the Incidence Of Surgical Site Infection After Inguinal Hernioplasty.

BACKGROUND: The risk of wound infection after elective inguinal hernia repair depends on several factors. One of the most important factors is the preoperative skin preparation. The use of antisepsis is performed to reduce the risk of surgical site infections (SSIs) and to remove causing organisms. This work compares two different agent forms for preoperative skin preparation to prevent SSIs. OBJECTIVES: The objective of the study is comparing the effects of two different agents used for preoperative skin preparation and prevention of SSIs. MATERIAL AND METHODS: 100 adult patients were divided and randomized into two groups, each containing 50 patients. Both groups included patients that are scheduled for elective Lichtenstein inguinal hernia repair. The first group includes patients whose skin preparations were done with povidone iodine (PI) only. The second group included patients that are treated with two antiseptics; Alkosol (96% ethanol, isopropanol-30g and ortophenilphenol-0.1g) and povidone iodide. Alkosol is applied before the induction of anesthesia. The povidone iodide is applied after Alkosol has evaporated. The presence of bacterial growth in the wound was determined 24 and 48 hours after operation. Swabs were used to take samples, which were then cultivated to check for bacterial growth. The presence of infection was also determined by the following criteria: pain or tenderness, induration, erythema, local warmth of the wound etc. RESULTS: The surgeon or clinician declared that after 24 hours the wound was infected in 20 patients in the control group and in 22 patients after 48 hours. In the Alkosol (96% ethanol, isopropanol-30g and ortophenilphenol-0.1g) and povidone iodide group infection was declared in only 3 patients after 24 hours. DISCUSSION: Compared to the use of providone only, the use of Alkosol (96% ethanol, isopropanol-30g and ortophenilphenol-0.1g) and povidone iodide has many advantages and was associated with lower rates of SSIs following clean surgery. A larger trial is warranted in order to add definitive and more conclusive data to the current evidence base.

Distance learning perspectives.

The development of modern technology and the Internet has enabled the explosive growth of distance learning. distance learning is a process that is increasingly present in the world. This is the field of education focused on educating students who are not physically present in the traditional classrooms or student's campus. described as a process where the source of information is separated from the students in space and time. If there are situations that require the physical presence of students, such as when a student is required to physically attend the exam, this is called a hybrid form of distance learning. This technology is increasingly used worldwide. The Internet has become the main communication channel for the development of distance learning.

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.

Social networks in medical education in bosnia and herzegovina.

INTRODUCTION: Beginning with the late twentieth and early twenty-first century, the Internet was a significant additional tool in the education of teenagers. Later, it takes more and more significant role in educating students and professionals. GOAL: The aim of this paper is to investigate, to what extent and how effectively the Internet is used today by students of biomedical faculties in Bosnia and Herzegovina. In addition, more specifically, this paper will research the implications of the well-known social networks in education of students and health professionals in Bosnia and Herzegovina. We compared the ratio of using Social networks by students for spreading medical information as basics for health education at medical faculties at 3 universities in Bosnia and Herzegovina (B&H). RESULTS AND DISCUSSION: The results showed that only 11.6% of professors use Facebook type of social network, 49.3% of them have a profile on BiomedExperts scientific social network and 79% have available articles in the largest biomedical literature database MEDLINE. Students are also frequent users of general social networks and educational clips from You Tube, which they prefer to utilize considerably more than the other types of professionals. Students rarely use the facilities of professional social networks, because they contain mainly data and information needed for further, postgraduate professional education. CONCLUSION: In B&H there are decent conditions for the use of online social networks in the education of health professionals. While students enthusiastically embraced these opportunities, this is not so much a case with health care professionals in practice; while scientific health care workers have not shown greater interest in the use of social networks, both for purposes of scientific research and in terms of self-education and training of students.

Role of laboratory diagnostic medical biochemistry services -analysis of requirements for the laboratory test in the laboratory of primary health care center.

INTRODUCTION: Laboratory diagnosis of medical biochemistry activity plays a significant role in the Primary Health Care Center (PHCC), dominated by Family medicine and diagnostic services. Medical biochemical diagnosis has a visible place at all levels of health care, which shows the number of requests for laboratory diagnosis, number and type of required laboratory tests. MATERIALS AND METHODS: The study included 1000 requests for laboratory tests at the PHCC in Gracanica in primary health care units. We made an analysis of the most common laboratory tests in the requests by doctors from primary health care based on requests for laboratory diagnosis. RESULTS: The requests of primary health care units in PHCC laboratory tests are required at all levels of service: urine, WBC, SE, glucose, total bilirubin, ALT, AST, AF, CK, cholesterol, HDL cholesterol, triglycerides, creatinine, urea, uric acid, CRP, fibrinogen, calcium and phosphorus. The following requirements are the most common laboratory tests with 94% representation: urine, WBC, glucose, cholesterol, triglycerides, aminotransferases, creatinine, and urea. In 1000 requires was required total of 5333 laboratory tests. Test requirements of a general practice make 44, 1%; FM doctors account for 40% and the requirements of other specialists (pediatricians, gynecologists and specialists of occupational medicine) are 15, 3%. The doctors in family practice most often required: glucose, urine, WBC, SE, TGL., Chol., ALT, AST, creatinine and urea. General practitioners are demanding more cholesterol and triglycerides, a family medicine doctors are demanding lower cholesterol and triglycerides and higher CRP, fibrinogen, total bilirubin, ALT, AST, and other specialists the most demanded urine and WBC. DISCUSSION: Laboratory diagnosis is a common diagnosis, which shows the representation of required number and type of laboratory tests. In requirements of PHC units in PHCC laboratory tests are required at all levels of service: urine, WBC, SE, glucose, bilirubin, ALT, AST, AF, CK, cholesterol, HDLchol., triglycerides, creatinine, urea, uric acid, CRP, fibrinogen, calcium and phosphorus. The following requirements are the most common laboratory tests at the primary level: urine, WBC, glucose, cholesterol, urea, and found the secondary level of triglycerides, index levels and did not clear the number of searches required by the standards and norms of PHC.

Characteristics of acute abdominal pain in lower abdomen in patients hospitalized in general hospital Tesanj.

BACKGROUND: Pain in the lower abdomen is one of the leading reasons that lead the patient in surgery. Although appendicitis is the most common cause in about two thirds of patients the other causes must be taken into account. OBJECTIVES: To determine the probabilities which could determine what is an etiological cause of pain. MATERIALS AND METHODS: comprised 102 patients hospitalized in general hospital Tesanj because the clinical symptoms dominated by acute pain in the lower abdomen. The study was retrospective prospective clinical study. All data were collected in a special database and statistically analyzed. RESULTS: Of all the causes of abdominal pain in the lower abdomen the most common is appendicitis with a total of 62 patients, of which slightly more male patients (36) compared to female patients (26) or (57% male and 43% female patients). If we analyze the time elapsed from pain onset to patient visit of physician we can say that patient with more intense pain will visit physician sooner. Colic and intense pain is a characteristic of colon cancer (15 patients) and Crohn's disease. Dull pain is characteristic of omentum cyst, diverticulitis, and intestinal obstruction and was seen in one fifth of patients with colorectal cancer and one third of patients with acute appendicitis. Palpatory positive pain in Mc Burney's point distinguishes appendicitis from other causes in most cases. DISCUSSION: The decision-making in the treatment of abdominal pain is depending of nature of pain, intensity, spreading, and sensitivity to palpation and localization of pain that usually indicates the place where the sick organ transmits the inflammatory process to the parietal peritoneum. Other symptoms that accompany pain and laboratory tests can be of crucial importance.

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.

The role of international classification of diseases in assessment of patients with biliary tract disease.

One of the most common events in Surgical Ward is admission of patients with biliary tract disease. To evaluate such patients, it is necessary to create appropriate database and define attributes that will be analyzed. The patients should be divided in groups for analysis and data processing. There were 219 patients included in the study. All patients were selected on the basis of ICD-10 codes and then divided into categories according to the code. In order to assess selected patients, the database was created with all relevant questions about anamnesis, diagnostic tests and surgical procedures. The data about patients was entered into the database. It is possible to analyze data about the most frequent disorders of biliary tract. The most common entity was chronic cholecystitis with calculus and most common procedure was laparoscopic cholecystectomy. The other important attributes are also assessed. ICD-10 classification can be used as a basis for aggregation of data of the patients with biliary tract disease. Some of the codes are more frequent than others and some are rarely used.

Application of simple digital methods in the treatment of hemorrhoid disease.

The treatment of patient with relapse of bleeding after application of minimally invasive treatment of hemorrhoidal disease such as elastic band ligation, cryosurgical treatment Hemorrhoidal Arterial Ligation (HAL) can be presented as serious clinical problem in patients with concomitant diseases that can be contraindication for radical surgical treatment. We compared the Simple Digital Method and standard above mentioned minimally invasive ambulatory treatment. We used special proctoscope with Doppler Flowmeter in order to identify all branches of hemorrhoidal artery in the anal canal creating graphical presentation using specially adapted software. HAL method is then used to perform ligation of hemorrhoidal artery branches. The elastic ligatures (called gummiligatures) are then applied to the piles in which most prominent flow was registered using Doppler Flowmeter. Antibiotic prophylaxis and sedation was administered preoperatively. Special computer program registered all steps. Hemorrhoidal ointments and paracetamol were used after surgical procedure. Average number of identified hemorrhoid arteries branches was six, and total duration of the procedure was in average 28 min. We compared patient treatment with our method and standard methods. In tested group we noticed significantly fewer complications (after eight days the number of complications 11% vs. 74%, p<0.001, after 15 days 3% vs. 11%: p=0.101). One year after procedure, the treatment was successful in 91.4%, or 32 out of 35 patients according to proctoscopy and Doppler Flowmeter exam. There were three patients with relapse of symptoms. In 77% of patients hat were treated with rubber bands ligation relapse occurred. Our method is significantly more successful in comparison to classical methods of ambulatory treatment and can be alternative to radical surgical treatment.

Quality assessment of medical education and use of information technology.

Extensive and fast advancements in biomedical sciences created a significant delay in receiving relevant and updated information in medical practice - physicians use old techniques and treat patients incorrectly. Bosnia and Herzegovina signed the Bologna Declaration on 18 September 2003, and in the light of this new approach to university education, and the process of joining The European Union, the authors set the following aims: to determine the current level of knowledge among medical students at the Medical Faculty of the University of Sarajevo, to determine the level of knowledge among medical students before their enrolment at the faculty, and to find out students opinion on their needs for further education. Students also left their suggestions on what should be changed in the curriculum. 203 students were included in the survey and results show that they demand more practical work, direct contact with patients and presentation of interesting clinical cases. Many of them use the internet as professional education means. Professional papers are rarely used. At present, the availability of learning material is insufficient at the faculty library.

Laparoscopic appendectomy in Bosnia and Herzegovina: the state of laparoscopic procedure in the treatment of acute appendicitis.

BACKGROUND: Laparoscopic appendectomy (LA) has recently become a standard procedure in the treatment of acute appendicitis, as it has been shown to be advantageous over open appendectomy. Since laparoscopic appendectomy was recently introduced in Bosnia and Herzegovina, we evaluated the practice of this procedure in the treatment of acute appendicitis. METHODS: An audit was carried out through a written questionnaire sent to 16 different medical hospitals in Bosnia and Herzegovina. The questionnaire examined the use of laparoscopic appendectomy since the period of its introduction to the end of 2007, including operative time, hospital stay, morbidity and mortality rates, conversion rate and the reasons for the conversion and laparoscopic technique. RESULTS: The response rate from the questionnaire was 37.5%, but only three institutions (18.75%) perform LA. The mean interval from introduction of laparoscopic surgery to inception of LA was 5 years. In period from inception of LA to the end of 2007, 243 appendectomies were done by laparoscopic approach. Correct diagnosis were made in 229/243 cases. Mean hospital stay was 2.2 +/- 0.4 days. Postoperative complications were observed in 13/243 patients. The most frequent complications were intrabdominal abscess (4/13), wound infection (4/13) and intrabdominal bleeding (2/13). Nine conversions from LA into open procedure were done, two due to technical reasons (equipment malfunction), two due to mesoappendix bleeding and five due to periapendicular block or retrocecal position. Conversions and postoperative complications were observed only at the start of the introduction of this procedure. CONCLUSION: Only three institutions in Bosnia and Herzegovina, with small surgical teams, routinely perform laparoscopic appendectomy. Thus, there is a need for systemic education of surgical teams across the country. Laparoscopic appendectomy could be the first operation in the acquisition of laparoscopic skills.

Tele-education as method of medical education.

Development of computer networks and introduction and application of new technologies in all aspects of human activity needs to be followed by universities in their transformation on how to approach scientific, research, and education teaching curricula. Development and increased use of distance learning (DL) over the past decade have clearly shown the potential and efficiency of information technology applied in education. Use of information technology in medical education is where medical informatics takes its place as important scientific discipline which ensures benefit from IT in teaching and learning process involved. Definition of telemedicine as "use of technologies based on health care delivered on distance" covers areas such as electronic health, tele-health (eHealth), telematics, but also tele-education. Web based medical education today is offered in different forms--from online lectures, online exams, web based continuous education programs, use of electronic libraries, online medical and scientific databases etc. Department of Medical Informatics of Medical Faculty of University of Sarajevo has taken many steps to introduce distance learning in medical curricula--from organising professional--scientific events (congresses, workshop etc), organizing first tele-exam at the faculty and among first at the university, to offering online lectures and online education material at the Department's website (www.unsa-medinfo.org). Distance learning in medical education, as well as telemedicine, significantly influence health care in general and are shaping the future model of medical practice. Basic computer and networks skills must be a part of all future medical curricula. The impact of technical equipment on patient-doctor relationship must be taken into account, and doctors have to be trained and prepared for diagnosing or consulting patients by use of IT. Telemedicine requires special approach in certain medical fields--tele-consultation, tele-surgery, tele-radiology and other specific telemedicine applications should be introduced to the curricula. Telemedicine and distance learning are best suited for medical education and doctor-to-doctor consultation--first contact between doctor and a patient should stay face-to-face when possible. In this paper, we present the results of the project Introduction and Implementation of Distance Learning at the Medical Faculty of University of Sarajevo and compare it with the following expected outcomes: development and integration of information technology in medical education; creation of flexible infrastructure which will enable access to e-learning to all students and teaching staff; improvement of digital literacy of academic population; ensuring high educational standards to students and teaching staff; helping medical staffto develop "life-long learning" approach in work and education.

Laparoscopic treatment of lower abdominal pain related to chronic appendicitis.

The appendicitis is one of the most common entities that could be met at surgical department. Chronic pelvic pain of right iliac fossa is common and it causes disability and distress and results in significant costs to health services. Often, investigation by laparoscopy reveals no obvious cause for pain. There are several possible explanations for chronic pelvic pain including undetected irritable bowel syndrome, the vascular hypothesis where pain is thought to arise from dilated pelvic veins in which blood flow is markedly reduced and altered spinal cord and brain processing of stimuli in women with chronic pelvic pain. As the pathophysiology of chronic pelvic pain is not well understood, its treatment is often unsatisfactory and limited to symptom relief. We aimed to identify and review treatments for chronic pelvic pain related to appendicitis. Frequently ultrasound and CT scan cannot confirm the diagnosis of chronic appendicitis due to non significant swelling of vermiform appendix. The study excludes patients with a diagnosis of pelvic congestion syndrome, those with pain known to be caused by gynecological disorders or irritable bowel syndrome. Detailed history, clinical examination, and serological and radiological investigations failed to reveal the cause of the pain in all cases. We presumed that pain is caused by chronic appendicitis with appendicolithiasis and that removal of appendix will result in symptom relief. We performed study with 75 patients treated by laparoscopic appendectomy. Duration of symptoms ranged from 3 to 48 months, with a mean of 13.1 months. All patients included in this study had right iliac fossa pain lasting more than three months. We performed radiological contrast studies to verify appendicolithiasis of irregularity of appendicular wall. Patient with mild symptoms were excluded, only patients that have symptoms that cause disability were operated. We compared pain according to localization, duration and character. We evaluated the pain one month after operation and compared its characteristics with preoperative pain. There is strong evidence that postoperative pain is significantly lower in operated patients and most of them are without any symptoms after operation.

Cervical pain syndrome as consequence of computer use in daily practice.

CONFLICT OF INTEREST: NONE DECLARED NECK PAIN SYNDROME IS DESCRIBED AS: Pain in the neck affects at least once in a lifetime every second person, and also 10 % of adult population suffers from chronic pain in this area. It is more often among women. A constant increase of incidence in the industrialized countries is noticed. It is also the leading cause of referral to physical rehabilitation. It is causing huge financial costs in the health care system. There is no consensus regarding Neck pain syndrome management, but many therapeutic modalities are applied: a) to isolate (or manage) rare, but potentially dangerous states that can cause neck pain; b) identify and treat each co morbid state and risk factors; c) provide resources and information's, especially about regarding use computers in dayly practice. Physical and manual treatments can be: a) physical therapy can assist to achieve early mobilization and return to daily activities; b) active physical therapy , mobilization, manipulation and exercises can assure short time relief of neck pain; c) home based exercises, as shown by this research, can significantly prolong the pain free period, in case of patients with the chronic syndrome; d) Medications, combined with the exercise program and ergonomic improvements can be effective solution for the chronic or recurrent neck pain. Intensive treatments in Neck pain syndrome are: a) Surgical and other intensive treatment (rarely indicated); b) invasive treatments includes and percutaneous radiofrequent neurotomy and cervical epidural analgesis.

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.

[Hepatic tuberculosis as a rare cause of massive intrabdominal bleeding]. / Tuberkuloza jetre kao rijedak uzrok masivnog intrabdominalnog krvarenja.

We admitted 70 years old woman with signs of acute abdomen and severe hemorrhagic shock. The urgent laparatomy was done. We found necrosis of the right liver lobe with signs of diffuse hepatic disease. We removed necrotic liver tissue and applied perihepatic package in order to stop bleeding. Patient was sent to ICU. Six days after first operation operative removal of hepatic package was done and cholecystectomy due to gangrene of gallbladder. Patohistology revealed miliary tuberculosis of liver with necrosis. Laboratory findings showed severe hypoalbuminemia, leucopenia and anemia. Tenth day after first operation, patient developed ARDS that could not be treated successfully, so patient died next day.

Ten years of medical informatics education experience at the Faculty of Medicine in Sarajevo.

INTRODUCTION: The medical informatics as the separate medical discipline very quickly gets developed, both in Bosnia and Herzegovina. In our country, the medical informatics is a separate subject for the last ten years, regarding to the Medical curriculum at the biomedical faculties in Bosnia and Herzegovina is in accordance with the project of the education related to Bologna declaration and the project EURO MEDICINA. This year the Chair of the Medical Informatics of the Medical Faculty in Sarajevo celebrates ten years of its existence. WORK METHOD: By the descriptive method of the research which included the questionnaire of about 400 students of the biomedical faculties, we established the attitudes and we took into consideration opinions of the students of these faculties about the validity of the contents of the subject of the medical informatics, the availability of the adoption of the material by the theoretical and practical performance of the teaching process and the suggestions and recommendations of the students about the contents that have to be throwned out from the curriculum and the teaching material that needs to be included. WORK RESULTS: The research was performed using the separate questionnaire pattern data carriers with the defined characteristics for the quality assessment of the performed course. The total attitude of the assessed students speaks about dominantly expressed satisfaction with the majority of the parameters that are important for assessment of the quality and the tuition contents that was evaluated during the questionnaire. The results are shown in the tables and graphs, and they are describing the program of the tuition and the contents of the methodical units, and the system of the examination for the students using the method of "multiple choice". CONCLUSION: The education in the field of the medical informatics is based at the concept which is used in the developed countries of the world, and according the recommendations of the working groups of the European and world association of the medical informatics. The theoretical and practical teaching and training performance in the wholeness is performed by use of the computer equipment, and the final knowledge check of the students also is performed using the Data Base Management System MSAccess specifically designed to cover full teaching and training material by using questions set in the data base which encircled nearly 1500 questions combinations.