Medicine ethics as a public problem.

Ethics, especially medical ethics, is of a great importance in medical informatics field ethical principles have great importance in confidentiality, security, and access to patient records. This is not as simple problem as it looks in the first sight, and--in that context--it is significant that many jurisdictions have drafted laws in this regard. As medical informatics has been developed, this ethical problem is becoming very important for medical informatics. Many efforts to make fundamental principles "according to which data protection and access to official information could be reconciled" are made. The principles described in this paper are independent of any process, as they are based on ethical principles. It avoids any kind of conflict or misunderstandings. They can be a base for making of an ethical code for informatics in health care delivery. These principles are independent of any particular "laws", and they can serve as to establish uniformity of standards in medical informatics.

Public health in Bosnia and Herzegovina.

It has been presented flow of socio-medical development and implementation on former Yougoslavia and Bosnia and Herzegovina territory in last thirty years. The names of those who are deserved for socio-medical development and its insufficiency on the organization on health system and some specific parts of it. Doubtlessly, the social medicine, as science and profession, and specially that one in Bosnia and Herzegovina, had high level among other disciplines, but also as profession per se, specially at the International level. There is huge evidence of numerous projects, congress papers, recognized by indigenous and international audience.

[Computerized information system support in continuous quality improvement in hospital care]. / Podrska kompjuteriziranog informacionog sistema kontinuiranom podizanju kvaliteta bolnicke zastite.

DRG (Diagnosis Related Groups) classification system requests much of medical and financial data from patients record. We also need comprehensive Clinical Information System with computer database to manage such system. In our research we were using HCFA (Health Care Financing Administration) and AN-DRG (Australian National-DRG) methodology for DRG classification. We also used ICD 10-Revision for diagnosis coding. We have chosen ORL Clinic for DRG classification because of two reasons: 1) They treat two basic types of patients medical and surgical and 2) They had pretty good sorted patients' records. Our base for DRG classification was 1997 year. During our research we found many deficiencies in patient records in both its parts: medical and financial. Since all records were processed and stored manually, financial data didn't exist. So we had to use other ways for direct and indirect costs allocation (for Prospective Payment System purpose). In 1998 we processed 680 patient records (treated in 1997), and made DRG classification putting all 680 patients' records into 183 DRG: 47 medical and 136 surgical. This is so called CASE-MIX of the ORL Clinic for year 1997. DRG classification we made at Tuzla ORL Clinic was identical with HCFA DRG classification system in 92%.

[The first hospitals in Bosnia-Herzegovina]. / Prve bolnice u Bosni i Hercegovini.

This year in Bosnia and Herzegovina we celebrate three great healthcare jubelees: hundred and thirty five years of Turkish military hospital (nowadays General hospital) in Sarajevo (founded in June 1866) and the First Property of a Muslim religious hospital in Sarajevo (founded in October 1866), and fifty five years of the Medical faculty of the University in Sarajevo (founded in November 1946). In the time of the Turk, and later also the Austria-Hungarian government in Bosnia and Herzegovina of this and another, later founded hospital, played very important role in the taking care and the treatment of inhabitants. The hospital have during its history experienced the organizational and the functional changes, exemplary to time and conditions in which they existed. The author gives the more comprehensive section of the work and the functioning of the first hospital institutions at the bottom of our State, and state the more significant names whose contribution with their qualitative work is observed.

[Reconstruction of mental health services in Bosnia and Herzegovina]. / Rekonstrukcija sluzbe za zastitu mentalnog zdravlja u Federaciji Bosne i Hercegovine.

Psychiatric services in Bosnia-Herzegovina before the war disaster was fairly developed and one of the best organized services amongst the republics of the former Yugoslavia. The psychiatric care system was based on psychiatric hospitals and small neuropsychiatric wards within general hospitals, accompanied by psychiatric services in health centers. The onset of war in B&H brought devastation and destruction in all domains of life, including the demolition and closing of numerous traditional psychiatric institutions, together with massive psychological suffering of the whole civilian population. Already during the war, and even more so after the war, the reconstruction and reorganization of the mental health services was undertaken. The basis of mental health care for the future is designed as a system where majority of services is located in the community, as close as possible to the habitat of the patients. The key aspect of the system of the comprehensive health care is primary health care and the main role is assigned to family practitioners and mental health professionals working in the community. Large psychiatric institutions were either closed or devastated, or have their capacities extensively reduced. There will be no reconstructions or reopening of the old psychiatric facilities, nor the new ones will be built. The most integrated part of the psychiatric system are the Community based mental health centers. Each of these centers will serve a particular geographic area. The centers will be responsible for prevention and treatment of psychiatric disorders, as well as for the mental health well being. Chronic mental health patients without families and are not able to independently live in the community will be accommodated in designated homes and other forms of protected accommodation within their communities. The principal change in mental health policy in B&H was a decision to transfer psychiatric services from traditional facilities into community, much closer to the patients. Basic elements of the mental health policy in B&H are: Decentralization and sectorization of mental health services; Intersectorial activity; Comprehensiveness of services; Equality in access and utilization of psychiatric service resources; Nationwide accessibility of mental health services; Continuity of services and care, together with the active participation of the community. This overview discusses the primary health care as the basic component of the comprehensive mental health care in greater detail, including tasks for family medicine teams and each individual member. 1. Comprehensive psychiatric care is implemented by primary health care physicians, specialized Centers for community-based mental health care, psychiatric wards of general hospitals and clinical centers in charge of brief, "acute" inpatient care; 2. Primary mental health care is implemented by family practitioners (primary care physicians) and their teams; 3. Specialized psychiatric care in community is performed professional teams specialized mental health issues' within Mental health centers in corresponding sectors; 4. A great deal of relevance is given to development of confidence and utilization of links between primary health care teams and specialized teams in Mental health centers and psychiatric in patient institutions; 5. Psychiatric wards within general cantonal hospitals, departments of psychiatric clinics in Sarajevo, Tuzla, and Mostar, and Cantonal Psychiatric hospital in Sarajevo (Jagomir) shall admit acute patients as well as chronic (with each new relapse). Treatment in these facilities is brief an patients are discharged to return to their homes, with further treatment referral to their family practitioner or designated Mental health center; 6. Chronic mental patients with severe residual impairment in social, psychological, and somatic functioning, shall live in the community with their families or independently. Those chronic patients without families and economic and other resources to live independently shall be placed in supervised Homes in the communities where they live. The above delineated strategy of mental health care program in B&H has several fundamental and specific objectives, among which the most important are: Reduction of incidence and prevalence of some mental disorders, particularly war stress-related disorders and suicide; Reduction of level of functional disability caused by mental disorders through improvement of treatment and care of individuals with mental health problems; Improvement of psychosocial well being of people with mental health problems, through implementation of comprehensive and accessible service for community mental health care; and Respect of basic human rights of individuals with mental health disabilities. The program has been updated since 1996, after the two-year pilot program. The main goals for current two- and five-year period are: Implement the mental health care reform program by launching all 38 Mental health centers in the Federation of BiH by 2002; Complete the 10-day education and re-education of at least 50% of all professionals employed in mental health services in FB&H by 2002; and Achieve that 80 percent of all mental health problems are treated by family medicine teams (primary care practitioners) and specialized mental health services (Community mental health care centers) by 2005.

[Education in family medicine--a new approach]. / Edukacija iz porodicne medicine--novi pristup.

The subject of the family medicine on the medical faculties in Bosnia and Herzegovina existed from recently as a separate curiculum of the medical study. Until recently the contents of this discipline interpreted within the subject of the social medicine or the object of the primary healthcare protection, and programs of teaching were based mainly on Anglosaxon experiences. The fact is that some teachers of the medical faculty in Sarajevo had their own visions and programs of the family medicine which by years were tested in the units of the family healthcare protection in Sarajevo, Mostar, and Banja Luka, about what was published in our and foreign literature. New approach from the family medicine should be based on as follows: greater use of the standardized procedures for the improvement of the communication skills; revised educational procedure of all the participants 6 interdisciplinaryilly in the education of the family medicine; improvement of knowledge about methodlogy and the principles of the research; improvement of the techniques and knowledge about the maipulatin of the medical informations; development of the skills of the continued studying through the total working aga; to the development of the capability of the critical estimation of the own work important; by the defining of the important educational goals in the curriculum of the urgent medicine; to the development and use of the methods feed-back informations from the students; to the modernizing of the methods of the evaluation of the educational process-adopted knowledge and the attitudes and the carrying out of the practice of the patients, and the ethic values in that process. In this work the authors consider the stated experiences in the education from the subject family medicine at our faculties realting to the foreign, and suggest that new concept of the education on the basis of these experiences in the practice.

[Pathography and biography of the Empress Maria Theresa]. / Patografija i zivotopis carice Marije Terezije.

The empress and queen Maria Theresa Habsburg-Lorraine (May 13th, 1917-November 29th, 1780) bore sixteen children in the marriage with the emperor Franz I Stepha and was famous as "mother-in-law of Europe". Her brother Leopold died immediately after he was born, her sister Amalia died in the cradle and Maria Ana died of perinatal complications at the birth of a dead infant in 1744. The famous hereditary facial dysmorphia of the "Hasburg jawe" wasn't noticed in Maria Theresa's surviving children. In October of 1738, after giving birth to her daughter Ana, a manual lysis of the placenta was performed due to the retained placenta and postpartal bleeding. In 1741 her daughter Carolina died, and in 1767 her daughter Josepha died of small pox. Her daughter Elizabeth remained deformed by the pock marks, and Maria Christina got a puerperal sepsis, but surprisingly, didn't die. Maria Antoinette ended under a guillotine in France, along with her husband Luis XVI. Maria Theresa's father, Karl VI died of the cholecystopankreatitis and peritonitis, and her husband and co-ruler most probably died of acute coronary incident in August 18th, 1765. After her husband's death she started suffering from depression with steady necrophile obsessions. Maria Theresa suffered from a chronical obstructional pulmonary disease (asthma), rehumatic syndromes, hypertension and anxiodepressive syndromes. In 1767 she had small pox. In November 11th 1780 she caught a cold which grew into a pneumonia with high fever. She died of cardiopulmonal dedompensation preceded by pneumonia and asthma.

[Typing of isolated mycobacteria]. / Tipizacija izoliranih mikobakterija.

Microbiological diagnosis of causes of pulmonic or other tuberculosis localization includes microscopic analysis of disease material cause which was taken earlier, his specific elaboration and inoculation at appropriate bases. Bases are incubated until 12 weeks. In the purpose of identification of M. tuberculosis complex or some other (conditionally) potentially pathogenous king of micobacterium, depending on immunity status of the investigated one, it is necessary to apply conventional as well as modern methods of molecular biology in laboratory work. First of all this means differentiation of M. tuberculosis complex from other bacterium (MOT), that is eventually differentiation inside complex. Beside classical tests it is possible to apply some methods of molecular biology in laboratory conditions, as well as nucleus sonds or method for reproduction of one part of nucleus acid which fragments, with a help of restrictive encimes, into several parts (PCR/PRA). With this method it is possible to do complete identification of isolated kinds of micobacterium according to the size of aplicon's fragments (part of reproduces DNA). An appropriate time, which is necessary for execution of these tests, is measured in hours and days, and for the classical tests in weeks and months.

[Abu al-Qasim Az-Zahrawi--a great Arab surgeon] . / Abu al-Qasim Az-Zahrawi--veliki Arapski hirurg.

History is a witness of the great importance and influence of islamic science from the period of "Golden Age of Arabic Civilisation". A famous scientist said: "Science has no country, it is international; we all share in fruits of investigations of people from different traditions and all ages." There are many worldwide famous arabian scientists: El-Kindi, Er-Razi, Ibn Sina, El-Biruni, Ibn Hajsem, Ez-Zahravi, El-Farabi, Ibn Zuhr, Ibn Ruzd etc. These names, among several hundreds of arabian physicians, attribute "Golden Age" of islamic science. That period was characterised by movements, reprocessing of ideas. That reprocessing of ideas has gained the great minds together, and that process is continuous. That is why we have to be grateful to them. One of them, who is not enough famous within medical professionals, Az-Zahrawi, belong to the greatest surgeons in the arabian "golden age" period.

[Reforms and modernization in the emergency medical care system in the Federation of Bosnia and Herzegovina]. / Reforma i modernizacija sistema hitne medicinske pomoci u Federaciji Bosne i Hercegovine.

This paper reports on the result of an in-depth review by the Federal Ministry of Helath (MOH)/This review was undertaken by an expert committee appointed to review the delivery of emergency healthcare services in the context of the overall organizational structure of the country's healthcare system. Within their mission to reform health care system in Bosnia and Herzegovina. It was worked out by the expert commission for the development of the health care organizational scheme proposal, in part dealing with urgent medical services. The committee's followed the universal and well-documented principle that 1) The timely delivery of particularly pre-hospital emergency healthcare reduces unnecessary loss-of life and disability 2) The timely delivery of emergency healthcare has a positive impact on effectiveness and efficiency of the overall performance of the healthcare systems. A retrospective analysis of pre-hospital emergency services based on a systems analysis, procedures and experiences revealed the need for a system approach such as documented, for instance, by the National Highway Traffic and Safety Administration (NHTSA) "Agenda for the Future" in the U.S.A. A preliminary set of recommendations was made which requires further follow up, particularly through an international dialogue at Conference like these. Of paramount importance is the development of a systems approach to the delivery of Emergency Healthcare, both in the pre-hospital and in-hospital domain. This systems approach should be developed in the context of the overall infrastructure and healthcare system of BiH. When such an organizational concept is accepted as a "doctrine", then it will be possible to establish a truly national system, with--and this is of great importance--a set of minimum quality standards attached.

[Use of telematics in emergency medicine]. / Primjena telematike u urgentnoj medicini.

Health telematics is a composite term for health-related activities, services and systems carried out over a distance by means of information and communications technololgies, for the purposes of global health promotion, disease control and health care, as well as education, management, and research for health. The concept of health telematics encompasses the following functional areas:--tele-education;--telemedicine;--telematics for health research;--telematics for health services management. Communications technologies are rapidly revolutionizing health care. For example, electronic communications support diagnosis and treatment of disease. TeleMedicine is an umbrella term for growing disciplines such as TeleRadiology, TelePathology, TeleCardiology, TelePsychiatry and TeleEducation. TeleMedicine is a component of TeleHealth, which includes the use of telecommunications technology and services for the surveillance and control of diseases and education. In this article authors describes the role of telemedicine and telematics in medical education and medical praxis.

[Medical treatment and air transport evacuation (initial view and project realization)]. / Medicinska pomoc i evakuacija zracnim transportom (inicijalno razmatranje--projekat-realizacija).

In this paper is presented modality of emergency medical transport by air. Here are a lot of examples of this way of organisation in developed countries as Europe and USA. This way of transport is very effective system of air transport, and it will be very practically in the future in countries in transition as B&H.

[Therapy of the Melkersson-Rosenthal syndrome with kenalog]. / Terapija Melkersson-Rosenthal sindroma sa preparatom kenalog.

IA case of Melkersson-Rosenthal syndrome with major and minor symptoms is presented. Clinical diagnosis was established on the basis of the triad: macrocheilia, lingua plicata and facial paralysis and a number of minor symptoms. The upper lip macrocheilia with palpation evident infiltrates corresponded to the diagnosis of granulomatous cheilitis of the upper lip. The upper lip was of intense red color, with the vermilion border effaced causing a marked cosmetic defect. The predominant subjective symptoms were burning and itching sensations with a reduction of movement of the lip. Clinical examination and palpation revealed three granulations enclosed by fissures. A slight exfoliation of the epithelia with serous exudate was dominant feature. The patient was admitted to the Oral Medicine Department of Dental School in Sarajevo on October 8th 1999 for macrocheilia relapses. The therapy using subcutaneous application of kenalog-40 suspension once a week in duration of five weeks showed substantial improvement. According to the prognostic criteria and the control examinations there were no relapses.