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.

[Expert systems in pulmonology]. / Ekspertni sistemi u pulmologiji.

Expert systems are software systems that can successfully compare to human experts. Their purpose is mostly advisory. Besides, they give explanation and advices to human experts when performing certain tasks. They are intelligent information systems, and are capable to explain and justify their conclusions. Knowledge systems are smaller software systems, and are usually less successful than human experts. Main reasons for expert systems development in medicine are: need for justification of decisions, need for enhancing performances in many uncertain relations; need for explaining of decision making process++ etc. One of the reasons of developing knowledge-based systems was that conventional statistic formalisms have not provided satisfactory solutions in medical decision making (MDM). Also, today, the relations between cases and conclusions are not universally valid. So, few causes can provide the same conclusion. Besides, data are not necessarily absolutely accurate. The area of applying expert systems is very wide: diagnosis, prognosis, education, managing etc. Basic structure of expert system consists of: knowledge, data base, inferring mechanism, explaining mechanism and user-interface. In this paper we presented several expert systems which are actually used in practice, especially in internal disciplines: Internist, Mycin, Onkocyn, DXplain.

[Modern methods in the diagnosis of tuberculosis: PCR--polymerase chain reaction]. / Savremene metode u dijagnostici tuberkuloze: PCR--polymerase chain reaction.

The diagnosis of tuberculosis depends on many factors but essentially on the detection of mycobacteria, their identification to the species level, and their susceptibility to major antituberculous drugs. The classic tests (direct examination-Ziehl-Neelsen, conventional culture and antibiotic susceptibility tests) are combined with modern tests (the molecular tests such as genomic amplification /PCR/ direct from clinical samples). By Polymerase Chain Reaction (PCR) over a billion identical bacteria could be multiplied from a single DNA molecule. These modern tests shortened diagnostics duration from several weeks to one or two days. The sensitivity of PCR test was 97% for Z-N positive, 68% for Z-N negative samples while specificity was 99% either for Z-N positive or negative samples.

Education of medical informatics in the medical curriculum on biomedical faculties in Sarajevo.

In this paper author discussed about experiences of implementing curriculum of education of Medical informatics on biomedical faculties in Sarajevo. Theoretical and practical part of education process, according to new curriculum, during 6 years period of studying at Faculty of medicine in Sarajevo, is hold within the second semester and consists of 30 hours. At Faculty of Dental Medicine in Sarajevo, education is hold in the fourth semester, and consists of 45 hours. At Higher Medical School in Sarajevo, education is also hold in the fourth semester, and consists of 30 hours of theoretical and 30 hours of practical hours as well. Curriculum of Medical Informatics is identical at all these three institutions. Faculty of Dental Medicine education process points out dental informatics, and Higher Medical School devotes more time in education on nursing informatics.

[Importance of health information systems in the process of reform and reconstruction of health care]. / Znacaj zdravstvenog informacijskog sistema u procesu reforme i rekonstrukcije zdravstva.

Reform and reconstruction of health care system can not be carried out without health information systems and modern information and communication technologies. In other hand, health information system of The Federation of BiH must be an object of both reform and reconstruction. This thesis points out that reform of health information system is a crucial priorities in order to improve and fasten reform. There is a paradigmatic question: who provides service, to whom, what is the price, and what is the final solution? In order to answer this question, an integral health information system that will be computer supported is necessary. For integral work and information exchange, computers must be connected and follow the same operating procedures. Benefits of an integral health information system, as well as impact factors for its implementation are discussed in the paper.

[AIDS and Islam]. / AIDS i islam.

There is very little information available on AIDS in Muslim countries. The World Health Organization (WHO) relies on government figures, but it concedes that these are far from accurate. At the beginning, many Muslim countries refused to provide statistics to WHO, and although under-reporting still continues, they have begun to accept the presence of the disease. In the absence of concrete data, many Muslim countries take solace in the widely accepted belief that Islamic cultural values provide a degree of protection against AIDS. And certainly, some studies show that Muslims living in traditional societies appear less likely to contract virus. It is the truth that Islam promotes a line of behaviour for HIV/AIDS prevention. But theory is not necessarily put into practice. Faced with an international pressure, most of the governments in Muslim countries have set up their AIDS control programmes today.

[Electronic medical records in Bosnia-Herzegovina. The electronic card--the medical record of the future in Boznia-Herzegovina]. / Elektronski zdravstveni karton u BiH. "Elektronska kartica--zdravstvena knjizica buducnosti i u BiH".

The biggest problem in organisation of the effective and rational health care of good quality in Bosnia quality and Herzegovina is a functional and updated Health Information System. In this system, important role play Health Statistic System in which documentation and evidence are very important segment. Developed countries proceeded from the manual and semiautomatic method of medical data processing and system management to the new methods of entering, storage, transfer, searching and protection of data using electronic equipment. Recently, the competition between manufacturers of the Smart Card and Laser Card is reality. Also scientific and professional debate exists about the standard card for storage of medical information in Health Care System. First option is supported by West European countries that developing Smart Card called Eurocard and second by USA and Far East countries. Because the Health Care System and other segments of Society of Bosnia and Herzegovina innovate intensively similar systems, the authors of this article intend to open discussion, and to show advantages and failures of each technological medium.

Ethical principles in health data protection.

Ethics, especially medical ethics, is of a great importance in health data protection, and 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.

[Computer-supported radiologic diagnosis in stomatology]. / Stomatoloska radioloska dijagnostika podrzana racunarom.

In contemporary stomatology practice except routine of using X-rays methods in diagnostics of jaws and teeth, the newer methods as computerized tomography, magnetotheraphy and radiovisiotheraphy etc. are used. These methods provides the physicians doctors easier, faster and cheaper diagnostics of inflammation and other processes, and on the other hand, they provide less damages to patients [symbol: see text] organism, the basic characteristics and principles of work of some of these already mentioned diagnostic methods have been shown in the paper.

[Medical expert systems]. / Medicinski ekspertni sistemi.

Expert systems are software systems that can successfully compare to human experts. Their purpose is mostly advisory. Besides, they give explanation and advice to human experts when performing certain tasks. They are intelligent information systems, and are capable to explain and justify their conclusions. Knowledge systems are smaller software systems, and are usually less successful than human experts. Main reasons for expert systems development in medicine are: need for justification of decisions, need for enhancing performances in many uncertain relations; need for explaining of decision making process etc. One of the reasons of developing knowledge-based systems was that conventional statistic formalisms have not provided satisfactory solutions in medical decision making (MDM). Also, today, the relations between cases and conclusions are not universally valid. So, few causes can provide the same conclusion. Besides, data are not necessarily absolutely accurate. The area of applying expert systems is very wide: diagnosis, prognosis, self-education, directing etc. Basic structure of expert system consists of: knowledge, data base, inferring mechanism, explaining mechanism and user-interface. Though, expert systems also have certain bad features: primarily, they are not physicians i.e. they can not examine a patient. Furthermore, expert system that is good for one certain area is often not good for another one. There are some cases, when these systems can confuse a physician and make him to make a wrong decision. This occurs very often in two specific cases: when the clinical situation is urgent; and when accuracy of clinical information is not definite.

[Collecting, publishing and searching scientific and research information]. / Prikupljanje, publiciranje i pretrazivanje biomedicinskih naucnih i strucnih informacija.

Time of information in which we live resulted in the increase of the amount of the information exponential growth of the new kind of knowledge, flourishing of the familiar ones, and the appearance of the new sciences. Medical (health) informatics occupies the central place in all the segments of modern medicine in the past thirty years--in practical work, education and scientific research. In all that, computers have taken over the most important role and are used intensively for the development of the health information systems. Following activities develop intensively within the area of health informatics: health- documentation, health-statistics, health-informatics and biomedical scientific and professional information. Starting with the fact that in this century and especially after the World War II, great advancement in bio-medical sciences is visible, in Bosnia and Herzegovina, it is clear that as a result of the above increase in scientific research, in the number of scientists, and funds invested in scientific institutions, equipment and documentation, is visible. Innovations and developments in science demand analytic-synthetic processing of scientific information and their utilisation research. This can be realised by collecting sources (documents) for reading, noting, editing, discovering-which is the integral part of scientific developmental research. Scholarly journals as well as the publications that follow the latest events in the world of science, and inform their users in the area of bio-medicine quickly and efficiently, play an important role in the professional literature.

[Avicenna--a great physician and thinker]. / Avicena--veliki lijecnik i mislilac.

AVICENNA (980-1037), whose full name was Abu Ali al-Husayn ibn Abd-Allah ibn Sina, was the most renowned and influential medical man and philosopher of the medieval Islam. Over a three hundred of Avicenna's works have survived, ranging from encyclopedic treatments to short treatleses and covering apart from medicine, philosophy and science, religious, linguistic, and literary matters. He wrote some works in Persian, of which the Danishnama-yl 'Ala'i ("The Book of Science Dedicated to Ala's Dawla") is the most important. Most of his works, however, are in Arabic. His chief medical work is Al-Qanun fi't-tibb ("The Canon of Medicine"), a synthesis of Greek and Arabic medicine also includes his own clinical observations and views on scientific method. The most detailed philosophical work is the voluminous al-Shifa' ("The Healing"). Al-Najat ("The Deliverance") is largely a summary of al-Shifa', although there are some deviations. Al-Isharat wa al-Tanbihat ("The Directives and Remarks") gives the quintessence of Avicenna's philosophy, sometimes in an aphoristic style, and concludes with an expression of his mystical esoteric views, a part that relates to certain symbolic narratives which he also wrote.

[Computer databases and scientific and research information systems]. / Racunarske baze podataka i sistem naucnih i strucnih informacija.

Medical informatics, especially computer data bases for collecting, processing and searching of scientific and research informations and publications is important for medical science and for the medical practice. Medical scientific informatics has developed as a special part of medical informatics. It is very important for medical education, medical research and publishing in biomedical disciplines. This paper presents the main characteristics of scientific and research information, their resources, searching of medical literature from biomedical journals. A historical survey of the foundation of the System for Biomedical Scientific Information in ex Yugoslavia (SBMNI) has been presented, with its conceptual basis, the current organization, the achieved results and experiences obtained.

[The cost of tests and their informational content]. / Cijena testa i njegov informacijski sadrzaj.

The trade-off between the cost of a test and its information content are presented in this paper. In cost-effectiveness analysis, the ratio of diagnostic costs, including the risks of testings, to the number of cases detected provides and index of diagnostic benefit. This ratio may be useful under conditions of uncertainty.

[ECG in patients with hemorrhagic fever]. / EKG u bolesnika sa hemoragicnom groznicom.

We analyzed 128 electrocardiograms (ECG) of 43 patients with haemorrhagic fever associated with kidney syndrome (HFKS) during an epidemic in 1989, region around Sarajevo. The greatest number of alternations was noticed in toxic phase, and the smallest number in invasive phase of disease. All alternations were transient. Extended QT interval was dominant, and was found in 19 patients (45%). Tall and peaked T wave in the case of 17 patients or in 40%, during toxic and recovering phase, was the second by its frequency. As the third by its frequency, there was U wave manifestation. We found this kind of alternation in the case of 13 patients or in 31%. Incomplete right bundle branch block was the most frequent find during invasive phase of HTKS and it was found in 3/7 of all patients. The same thing was found in 6 patients more, during toxic phase, so in total it was 21%. First degree AV block was presented in 8 patients or 19%. Other finds, ischemia, P-pulmo, arrhythmia etc. had frequency less than 10%.

[The significance and role of medical information in decision-making in health care]. / Znacaj i uloga medicinskih informacija u donosenju odluka u zdravstvenoj djelatnosti.

The resolving of medical problems and medical decision making can not be imagined without information which have to be qualitative, on time and correct. These information, in essence, are high grade material that come from different sources. Health, respectively medical information are generated within health system as the result of every day doctors' activities. The most frequent sources of medical information are: medical documentation, reports about the work of medical staff, reviews, registers, reports about demographic and vital statistics, reports about medical activities etc. In the article we describe classification of medical information, and their most important characteristics, as the relevance and value of medical information. We emphasize the economic aspect of medical information as well.

[Acute viral hepatitis--present status and perspectives]. / Akutni virusni hepatitisi--sadasnje stanje i perspektive.

Recent advances in epidemiology, virology, of clinical of hepatitis are presented in the paper. The authors pointed out that hepatitis A never becomes chronic. On the other hand, with hepatitis B or B and D, evolution to chronicity is possible. Two distinct forms of non-A non-B hepatitis are now distinguished: parenterally transmitted non-A non-B hepatitis, mainly due to hepatitis C virus; enterically transmitted non-A non-B hepatitis mainly due to hepatitis E virus. C virus hepatitis is characterized by a frequent course to chronic hepatitis, cirrhosis and hepatocellular carcinoma. Chronic forms are associated with the presence of anti-HC antibodies in the serum. These antibodies are rarely present in the acute stage of the disease. Hepatitis E is almost exclusively encountered in developing countries. Like with A virus hepatitis, chronicity never occurs. However, fulminant hepatitis is possible in pregnant women in the third trimester of pregnancy. There is no routine serological test. Development of vaccines against A, E and C viruses can be expected very soon. There is no specific treatment of acute viral hepatitis.

[C-reactive protein values]. / Vrijednost C-reaktivnog proteina.

According to our research, C-reactive protein is powerful separator between bacterial and viral infections. For this case the best discriminative value is 40 mg/l. A more serious bacterial infections are usually followed by a higher concentration of CRP in serum, but its serial determination presents truly the improvement of bacterial infect, otherwise it is happening spontaneously or under the influence of adequate therapeutica.