[Patient-oriented optimization of the quality of care in a specialized outpatient clinic in a tertiary rheumatology center : A qualitative study]. / Patientenorientierte Optimierung der Versorgungsqualität in der ambulanten spezialfachärztlichen Versorgung (ASV) in einem tertiären rheumatologischen Zentrum : Eine qualitative Studie.

BACKGROUND: The adaptation of structures and processes in treatment procedures can contribute to increasing patient satisfaction and is the focus of patient-oriented quality assurance. OBJECTIVE: To identify patient satisfaction as well as needs, expectations and preferences with respect to care and, based on this, to formulate recommendations for action to optimize the quality of care at a large tertiary rheumatology center. MATERIAL AND METHODS: As part of a qualitative research approach, semi-structured patient interviews and a focus group interview consisting of physicians in rheumatology training in outpatient specialist care were conducted. The quality dimensions of Donabedian were recorded. The data material was evaluated and analyzed using the content-structuring qualitative content analysis according to Kuckartz with the MAXQDA evaluation software. RESULTS: Using 12 patient interviews and a focus group of 3 future rheumatologists, recommendations for action to optimize the quality of care were derived on the basis of the structural, process and outcome quality. There was a need for optimization in the areas of personnel management, internal practice processes, practice equipment and treatment processes in the outpatient clinic. CONCLUSION: The results from the patient interviews and the focus group revealed the aspects in need of optimization. The methodology and results of this study can serve as a reference point for analyses of other rheumatology clinics in order to improve the quality of care within the framework of patient-oriented quality management and continuous further development.

An Uncommon Instance of Tubal Pregnancy With a Vital Fetus at the Thirteenth Week of Gestation.

Ectopic pregnancy, characterized by the aberrant implantation of blastocysts outside the uterine endometrial lining, typically occurs within the fallopian tube. Clinical presentation of tubal pregnancy ranges from asymptomatic cases to a spectrum of symptoms, including amenorrhea, pelvic pain, vaginal bleeding, and, critically, hemorrhagic shock resulting from tubal rupture. Utilizing serum beta-human chorionic gonadotropin levels and ultrasound examinations is pivotal in confirming the diagnosis. Diagnosing tubal pregnancy during the first trimester is feasible and crucial to prevent rupture, yet reports of fatal cases persist due to delays in diagnosis or misdiagnosis. This paper presents a unique case of an advanced tubal pregnancy at 13 weeks of gestation, featuring a viable fetus. This case underscores the importance of timely and accurate diagnosis to avoid life-threatening complications. It highlights the critical need for heightened medical vigilance and continuous education among healthcare professionals in managing ectopic pregnancies effectively.

Managing pronounced hematocolpos in Herlyn-Werner-Wunderlich syndrome: A comprehensive case report.

Herlyn-Werner-Wunderlich (HWW) syndrome is a rare and complex congenital anomaly of the genitourinary system characterized by uterus didelphys, an obstructed hemivagina, and ipsilateral renal agenesis. It is the result of the maldevelopment of both the Mullerian and Wolffian ducts. Clinical manifestations of dysmenorrhea, dysuria, and urinary retention appear after menarche due to the accumulation of menstrual blood and distention of the obstructed hemivagina. Diagnosis of this anomaly is often delayed, and the obstructive nature of the condition is missed due to cyclic menstruation from the one canalized hemivagina. This case report represents a typical form of HWW syndrome to highlight the importance of considering this rare entity in an adolescent girl presenting with signs of dysmenorrhea and urinary complaints. A 13-year-old patient was presented at the obstetrics and gynecology clinic due to low abdominal pain and urinary retention on the fifth day of menstruation. For the last 6 months, the patient suffered progressive cyclic low abdominal pain associated with menstruation. Inspection of the external genitalia was unremarkable, and the hymenal membrane had a normal oval opening. An ultrasound examination revealed the sonographic features of the didelphys uterus and was suggestive of a right obstructed hemivagina with hematocolpos. Magnetic resonance imaging and computed tomography urography showed evidence of didelphys uterus, right blind obstructed hemivagina associated with huge hematocolpos, and ipsilateral renal agenesis. The diagnosis of HWW syndrome was established. Surgical resection of the vaginal septum was undertaken without delay, and the patient was discharged the following days.

Ultrasonographic examination and resolution of a pronounced hematocolpometra linked to an imperforate hymen: A detailed case study.

An imperforate hymen is a rare malformation present at birth; however, in most cases, diagnosis is missed until adolescence, when hematocolpometra and its symptoms develop. At this stage, every further delay in diagnosis and treatment will negatively affect the quality of life of young females. It may also be one of the causes of endometriosis and its consequences, such as subfertility. Sonography of the pelvis and physical examination are the diagnostic modalities of choice for diagnosing hematocolpometra and imperforate hymen. We present a case of a 14-year-old patient admitted to the obstetrics and gynecology clinic with complaints of lower abdominal pain and urinary retention following dysuria. The patient was previously examined by a family doctor who misidentified the issue and treated it as a urinary infection. After the symptoms worsened, the patient was referred to a gynecologist. An ultrasound examination showed a distended vagina and uterus, suggesting hematocolpometra, and after further inspection, it was revealed to be caused by an imperforate hymen. A hymenectomy was performed, and about 900 mL of blood was drained. Symptoms and complaints ceased, and the patient was discharged the next day.

Role of Calcium/Creatinine Ratio in Urine Compared with Proteinuria and Uric Acid in Predicting Preeclampsia: A Study from Kosovo.

BACKGROUND Preeclampsia is a common complication of pregnancy and a major cause of morbidity and mortality of mothers and babies worldwide. This study aimed to explore what the role of calcium/creatinine ratio is in urine compared with proteinuria and uric acid in predicting preeclampsia. MATERIAL AND METHODS In this prospective case-control study, 200 pregnant women who participated in the study were consecutively divided into 3 groups: a group of 59 women with preeclampsia, 61 women with pregnancy-induced hypertension, and a control group of 80 normotensive pregnant women. A 24-h urine sample was collected for estimation of calcium/creatinine ratio and proteinuria and a blood sample for estimation of uric acid at a gestational age of 24-34 weeks of pregnancy. RESULTS The study found that the sensitivity of proteinuria as a predictor of preeclampsia was 96.6% (P=0.000) and specificity was 21.3%. The sensitivity of uric acid as a predictor was 96.6% (P=0.000) and the specificity was 48.8%; whereas for the 24-h urine calcium/creatinine ratio, the sensitivity was 87.9% (P=0.000) and the specificity 40.7%, which corresponds to a value of 0.105 (cutoff). Women with a calcium/creatinine ratio <0.105 have a higher risk of developing preeclampsia (87.9% confidence interval, P=0.000). CONCLUSIONS The role of the calcium/creatinine ratio in urine is inferior to proteinuria and uric acid in predicting preeclampsia.

Early-onset neonatal infection in pregnancies with prelabor rupture of membranes in Kosovo: A major challenge.

OBJECTIVE: Prelabor rupture of membranes (PROM) is a common event in obstetrics that has a major impact in pregnancy outcome. This condition is linked to a number of pregnancy and birth complications with early-onset neonatal infection (EONI) being one of the major threats. This study was undertaken to determine the rate of neonatal infection in newborn infants with a maternal history of PROM and to evaluate the association of risk factors with neonatal infection following PROM. MATERIALS AND METHODS: A cross-sectional descriptive design was used to analyze a population of 200 pregnant women presenting to the Obstetrics and Gynecology Tertiary Center in Kosovo (between 2013 and 2015) with PROM who gave birth to single newborns. Data including demographic characteristics, neonatal outcome, and risk factors for infectious neonatal morbidity were recorded and analyzed. RESULTS: The study included 200 pregnant women with PROM and their newborns. Participant demographics included: the majority were young, aged between 20 and 29 years (67%), primiparous (67.5%), unemployed (92%), completed secondary level of education (83%), and with middle socioeconomic status (86%). Overall, 13% of the newborns had early-onset neonatal infection, and sepsis was proven in 5% of cases. Newborns of mothers with risk factors such as preterm (<37 weeks) PROM, low gestational weight at birth, prolonged rupture of membranes, maternal colonization, and low Appearance, Pulse, Grimace, Activity, Respiration score at birth had higher rates of infection compared with newborns of mothers without these risk factors. CONCLUSION: The rate of EONI in pregnancies complicated with PROM continues to be a global challenge in perinatology, and as this study reports, also a major challenge for Kosovo. Future research, revision and improvement on prenatal care and practices, timing of delivery, medical treatment, and prophylactic use of antibiotics in PROM are needed to reduce rates.

Prelabour Rupture of Membranes: Mode of Delivery and Outcome.

BACKGROUND: Pre-labour Rupture of Membranes (PROM) is an important cause of maternal and fetal morbidity and increased rate of cesarean section delivery. AIM: The aim of this study is to investigate the clinical characteristics, PROM-delivery interval, mode of delivery, and early maternal neonatal outcome among pregnant patients presenting with pre-labour rupture of membranes. MATERIAL AND METHODS: This prospective case control study is implemented at the Obstetric and Gynecology Clinic of the University Clinical Center of Kosovo. The study included 100 pregnant patients presenting with prelabour rupture of membranes of which 63 were primigravida and 37 patients were multigravida. RESULTS: The incidence of cesarean section in this study is 28 % and the most common indications for cesarean delivery were fetal distress, malpresentation, cephalopelvic disproportion, and failed induction. The most common maternal complications in this study are chorioamnionitis, retained placenta and postpartum hemorrhage. Neonatal infectious morbidity was present in 16 % of cases. CONCLUSION: PROM is a significant issue for obstetricians and an important cause of maternal and neonatal morbidity and increased rate of cesarean section delivery.

Refusal of treatment for acute leukemia in pregnancy: a case report.

INTRODUCTION: Acute leukemia is rare in pregnancy. The importance of promptly diagnosing and treating this disease in pregnancy stems from its life-threatening potential, both to the mother and fetus. CASE PRESENTATION: We report a case of relapse of acute myeloid leukemia at 23 weeks of pregnancy in a 24-year-old Albanian woman. Our patient categorically refused chemotherapy treatment, and in her 35th week of gestation, severe hemorrhagic diathesis rapidly developed. The manifestation and course of this life-threatening complication posed therapeutic challenges for the attending medical team. CONCLUSION: Based both on our experience and the results of other gynecological studies, there exists a strong indication that the earlier a patient's chemotherapy treatment begins, the better the maternal outcome. We support chemotherapy for patients who are pregnant presenting with such illness. The present case report testifies that refusal of chemotherapy by such patients is a high-risk decision.