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Plućni edem je komplikacija zatajenja srca koja ima postotak jednogodišnje smrtnosti od 40%. To je stanje u kojem zbog popuštanja lijeve klijetke dolazi do plućne hipertenzije i nastanka tekućine u alveolama, te posljedično tome nakupljanju tekućine u plućnom intersticiju. Manifestira se kao kardiogeni ili nekardiogeni plućni edem. Kardiogeni edem pluća za uzrok ima bolest srca, dok nekardiogeni mogu uzrokovati druga stanja ili čimbenici poput akutnog respiratornog distresa (ARDS) te direktne ili indirektne ozljede pluća. U kliničkoj slici prevladava dispneja. Također se očituje i cijanozom okrajina i usnica, korištenjem pomoćne muskulature pri disanju, orošenost hladnim znojem te nekad i poremećajem svijesti. Daljnjim razvojem edema dolazi do otežanijeg disanja, pojavljuje se inspiratorni hropci i iskašljavanje vodenastog, pjenušavog sadržaja koji ima primjese krvi. Dijagnoza se postavlja na temelju kliničke slike, anamneze, fizikalnog pregleda, RTG snimkom pluća i EKG-om te laboratorijskim nalazima. Plućni edem liječi se istovremeno s kontinuiranom dijagnostičkom obradom. Terapija se postiže kisikom, diureticima, vazodilatatorima i morfinom. U sprječavanju edema pluća veliku odgovornost imaju i medicinske sestre / tehničari. Njihova uloga je važna u liječenju, dijagnostici, prevenciji i edukaciji bolesnika. Zbrinjavanje bolesnika s plućnim edemom provodi se na temelju procesa zdravstvene njege i holističkog pristupa. Od velike važnosti je precizna procjena stanja bolesnika radi boljeg prepoznavanja problema iz područja zdravstvene njege, dobre izrade plana zdravstvene njege što rezultira ispunjenjem ciljeva. Pulmonary edema is a complication of heart failure that has a one-year mortality rate of 40%. It is a condition in which, due to the loosening of the left ventricle, pulmonary hypertension and the formation of fluid in the alveoli occur, and consequently the accumulation of fluid in the pulmonary interstitiality. It manifests itself as cardiogenic or non-otherrdiogenic pulmonary edema. Cardiogenic lung edema has heart disease to cause it, while non-nerdiogenic can cause other conditions or factors such as acute respiratory distress (ARDS) and direct or indirect lung injury. The clinical picture is dominated by dyspnea. It is also manifested by cyanosis of okranine and lips, using auxiliary musculature when breathing, cold sweat decomposed and sometimes a disturbance of consciousness. With the further development of edema, breathing problems become more pronounced, whooping and expectoration of the watery, frothy content appears, which may have admixtures of blood. The diagnosis is made on the basis of a clinical picture, history, physical examination, X-ray of the lungs and ECG and laboratory findings. Pulmonary edema is treated simultaneously with continuous diagnostic treatment. Therapy is achieved by oxygen, diuretics, vasodilators and morphine. In preventing edema of the lungs, nurses / technicians also have a great responsibility. Their role is important in the treatment, diagnosis, prevention and education of patients. The care of patients with pulmonary edema is carried out on the basis of health care processes and a holistic approach. Of great importance is a precise assessment of the patient's condition in order to better identify problems in the field of health care, to make a good health care plan resulting in the fulfillment of the goals.

An educated nurse has abilities to recognize and assess patients’ healthcare needs. Following the identified needs, the nurse organizes a healthcare process that meets the needs of patients. By standardizing education and professional practice, and recording the work of a nurse, the changes that are taking place in the nursing profession are recognizable. Certain activities related to the management and quality control of health services have set new requirements but also challenges for nurses and technicians. Traditional care, which until now was carried out exclusively on the doctor's order, has now been replaced by modern health care. The purpose of modern health care is an individual approach for each patient, which is properly recorded in the health care documentation. The study is exploratory, descriptive, analytical, and comparative. The author's original questionnaire was used as a study instrument, created based on a review of scientific and professional literature and experiences from clinical practice. The results of statistical data analysis are presented in tables and graphs by the absolute number of cases and percentages. Comparison and influence of individual factors were examined using the chi-square test, with test results considered significant at the 95% confidence level (p

U ovom završnom radu dotaknute su teme sestrinstva kao profesije te sama sestrinska njega kao temelj rada medicinskih sestara. Razvojem sestrinstva kao profesije i uvođenjem procesa zdravstvene njege zajedno sa sve većim brojem istraživanja iz područja sestrinske njege, formiraju se nova znanja i novi pogled na pacijenta. Razvija se usmjerenost medicinskih sestara na pojedinca kao na čovjeka, a ne isključivo na bolest kao što je to bilo povijesno gledano dugi niz godina. Pacijent postaje subjekt kroz proces zdravstvene njege što znači da sudjeluje u donošenju odluka o njegovom liječenju i zdravstvenoj njezi. Njega kao pojam obuhvaća mnogo više od provođenja standardnih medicinskih postupaka usmjerenih na fizičke potrebe. Ona se danas sve više razvija i kroz kontinuiranu edukaciju zdravstvenih djelatnika. U ovom završnom radu navedena su istraživanja koja potkrepljuju zadovoljstvo pacijenata pruženom zdravstvenom njegom. Prihvaćanjem drugačijeg pogleda na pacijenta kroz kontinuiranu edukaciju nastaje kvalitetniji zdravstveni sustav. Holistički pristup podrazumijeva gledanje pacijenta kao cjelovito biće, poštujući njegovu individualnost i autonomiju. Kroz proces zdravstvene njege, teoriju motivacije i biopsihosocijalni pristup objedinjujemo holistički pristup pacijentu. Koristeći širok spektar znanja pružamo zdravstvenu njegu na pravilan i kvalitetan način. Kontinuiranim usavršavanjem medicinskih sestara primjećujemo pozitivne ishode holističke skrbi. Naravno, sama kvaliteta pružene zdravstvene njege ovisi o mnogim parametrima. Dobra komunikacija je preduvjet stvaranja kvalitetnog odnosa. Poštovanje, empatija, razumijevanje i zainteresiranost za pacijenta objedinjuju etičke i moralne vrijednosti koje podsjećaju koliko je briga o pojedincu kompleksna i da profesionalnu medicinsku sestru treba pratiti velika ljubav prema svojoj profesiji da bi svoja znanja i kompetencije primjenjivala na najbolji mogući način. In this final paper, the topics of nursing as a profession and nursing itself as the basis of the work of nurses are touched upon. With the development of nursing as a profession and the introduction of the health care process together with an increasing number of research in the field of nursing, new knowledge and a new view of the patient are formed. Nurses ’focus on individuals as human beings is evolving, not exclusively on disease as has historically been the case for many years. The patient becomes a subject through the process of health care which means that he participates in making a decision about his treatment and health care. Care as a term encompasses much more than the implementation of standard medical procedures focused on physical needs. Today, it is increasingly developing through continuous education of health professionals. In this final paper, research is presented that supports the satisfaction of patients with the provided health care. By accepting a different view of the patient through continuous education, a quality health care system is created. A holistic approach involves looking at the patient as a whole being, respecting his individuality and autonomy. Through the process of health care, motivation theory and biopsychosocial approach, we combine a holistic approach to the patient. Using a wide range of knowledge, we provide health care in a proper and quality manner. Through the continuous training of nurses, we notice positive outcomes of holistic care. Of course, the very quality of health care provided depends on many of the parameters. Good communication is a prerequisite for creating a quality relationship. Respect, empathy, understanding and interest in the patient combine ethical and moral values that remind us how complex caring for an individual is and that a professional nurse needs to be accompanied by a great love for her profession to apply her knowledge and competencies in the best possible way.

International audience; Health care processes can be formally analyzed as involving two kinds of planned processes that are mereologically related: health procedures and health activities. They can involve a number of informational entities that derive from orders meant to fulfill requests such as prescriptions. This article provides definitions and axioms for such entities, following the OBO Foundry methodology. This representation could serve as a foundation for an ontological model that aims to enable interoperability between various clinical data sources in the context of a Learning Health System.

Onkologija je grana medicine koja se bavi prevencijom, dijagnozom i liječenjem ljudi od malignih bolesti. Maligna bolest obuhvaća sva stanja kod koji dolazi do pojave malignog tkiva (raka/tumora). Faktori rizika za njeno nastajanje su brojni, a postavljanje dijagnoze se sastoji od pravilno odrađene anamneze, medicinsko-dijegnostičkih pretraga (primarno slikovnih) i laboratorijskih pretrega (pozitivan nalaz tumorskih markera). Liječenje se sastoji od 3 zasebna medicinska postupka (kirurško liječenje, radio i kemoterapija), a potpunim izliječenjem se smatra izostanak bolesti u sljedećih 5 godina. Posao medicinske sestre/tehničara varira ovisno u kojem dijelu bolesti se uključuje u zdravstvenu njegu bolesnika. Zbog toga će se jedan bolesnik susretati s većim brojem medicinskih sestara/tehničara koji će biti zaduženi za različite zadaće tokom njegovog liječenja. Mogući problemi zdravstvene njege koji proizlaze iz primarne dijagnoze/bolesti ovise o samom stupnju uznapredovalosti kao i lokalizaciji tumora. Zato je proces zdravstvene njege kod ovakvog bolesnika izrazito opširan i stoga je rad podijeljen na 3 dijela. Prva se bavi problemima zdravstvene njege kod prijema bolesnika i samom spoznajom o bolovanju od maligne bolesti, drugi dio prikazuje probleme kod bolesnika koji je u procesu liječenja, a u trećem dijelu imamo bolesnika kod kojeg liječenje nije dalo pozitivan učinak i koji zahtijeva palijativnu skrb. Kao dodatak na kraju su obrađene i dvije dodatne teme koje se dotiču glavnih smjernica rada. Prva je posvećena samoanalizi nuspojava kemoterapije, a druga mobilnom timu palijativne skrbi Istarske županije., Oncology is a branch of medicine that deals with the prevention, diagnosis and treatment of people who have malignant disease. Malignant disease includes all conditions in which malignant tissue (cancer / tumor) occurs. Risk factors for its occurrence are numerous, and the diagnosis consists of a properly performed anamnesis, medical-diagnostic tests (primarily imaging techniques) and laboratory tests (positive presence of tumor markers). Treatment consists of 3 separate medical procedures (surgical treatment, radiotherapy and chemotherapy), and the complete curement is considered the absence of the disease in the next 5 years. The job of a nurse / technician varies depending on which part of the disease is involved in the patient's health care. Therefore, one patient will encounter a number of nurses/technicians who will be in charge of different tasks during his or her treatment. Possible health care problems arise from the primary diagnosis and depend on the degree of progression as well as the localization of the tumor. Therefore, the process of health care in such a patient is extremely extensive and therefore the paper is divided into 3 parts. The first deals with the problems of health care when a patient is committed to a hospital and his reaction to the knowledge of malignant disease, the second part shows the problems of a patient who is in the process of treatment, and in the third part we have a patient whose treatment did not give a positive effect and requires palliative care. In addition, two connected topics dealing with the main guidelines of the work were addressed at the end of the paper. First is dedicated to the pilot project of self-analysis of side effects of chemotherapy, and the second is dedicated to the mobile palliative care team of the Istrian County.

Timus je važan organ imunološkog sustava i njegova disfunkcija može drastično utjecati na kvalitetu života pacijenta. Timus raste do treće godine starosti, a zatim involuira tijekom puberteta. Timomi su relativno rijetki i obično indolentni tumori koji se predstavljaju nejasno i sa suptilnim simptomima. Polovica bolesnika s kortikalnim timomom razvija miasteniju gravis, dok 15% bolesnika s miastenijom ima timome. Klinička dijagnoza timoma dovoljna je za planiranje ekscizije tumora, kompletna kirurška resekcija, odnosno kompletna timektomija je optimalno rješenje. Uklanjanje timusa ima važnu ulogu kod miastenie gravis jer je dokazano da nakon odstranjenja tumora prednjeg medijastinuma dolazi do znatnoga kliničkog poboljšanja kod dijela bolesnika. Razvojem minimalno invazivne kirurgije, video asistirana torakoskopija (VATS), nameće se kao izvrsna alternativa klasičnim sternotomijskim postupcima. Uloga medicinske sestre je od velikog značaja u prijeoperacijskoj pripremi, za vrijeme operativnog zahvata, te u poslijeoperacijskoj skrbi, s obzirom da je upravo ona neprestano uz bolesnika. Zbrinjavanje bolesnika s učinjenom timektomijom zahtijeva stručno znanje medicinske sestre, prepoznavanje svake promjene kod bolesnika, reagiranje na komplikacije, te je medicinska sestra svojim znanjem i vještinama dužna pružiti najbolju skrb bolesniku. U ovom radu se opisuje timus kao organ, bolesti koje se mogu razviti, dijagnostika i kirurško liječenje, te zadaće medicinske sestre u procesu zdravstvene njege bolesnika koji je povrgnut operativnom zahvatu uklanjanja timusa., The thymus is an important organ of the immune system and its dysfunction can drastically affect a patient’s quality of life. The thymus grows until the third year of age and then involutes during puberty. Thymomas are relatively rare and usually indolent tumors that present indistinctly and with subtle symptoms. Half of patients with cortical thymoma develop myasthenia gravis, while 15% of patients with myasthenia gravis have thymomas. Clinical diagnosis of thymoma is sufficient for planning tumor excision, complete surgical resection, or complete thymectomy is the optimal solution. Thymus removal plays an important role in myasthenia gravis because it has been proven that there is a significant clinical improvement in some patients after removal of a tumor of the anterior mediastinum. With the development of minimally invasive surgery, video-assisted thoracoscopy (VATS) has shown as an excellent alternative to classical sternotomy procedures. The role of the nurse is of great importance in the preoperative preparation, during the operation, and in the postoperative care, given that she is constantly with the patient. Caring for a patient with a thymectomy requires the expert knowledge of the nurse, recognizing any changes in the patient, responding to complications, and the nurse is obliged to provide the best care to the patient with her knowledge and skills. This paper describes the thymus as an organ, the diseases that can develop, diagnosis and surgical treatment, and the tasks of the nurse in the process of patient care that has undergone surgery to remove the thymus.

Ulkusna bolest je ograničeno oštećenje sluznice probavnog trakta. Čak 10% populacije Zapadnog svijeta razvije ulkusnu bolest za vrijeme svoga života. U SAD-u svake godine od ulkusne bolesti oboli oko četiri milijuna stanovništva, gotovo cjelokupna populacija Hrvatske. Prosječna stopa stanovništva u Hrvatskoj u razmaku od 20 i 70 godina je između 60,4 % i 68 %. Stopa raste u starijim dobnim skupinama, posebno kod starijih osoba iznad 45 godina. U ovom završnom radu biti će prikazano etiologija, klinička slika, dijagnostički postupci, liječenje ulkusne bolesti, te također proces zdravstvene njege kod takvih bolesnika. Zadatci medicinske sestre jesu procjena i praćenje zdravstvenog stanja bolesnika, u suradnji s ostalim članovima multidisciplinarnog tima (liječnik gastroenterolog, klinički nutricionist), te osim standardnih protokola liječenja potrebno je usmjeriti bolesnika u načine prehrane koja tijekom liječenja postaje specifična kako za bolesnika tako i za njegovu obitelj. Sestrinska edukacija temelj je na kojem se podiže stupanj kvalitete života. Također osim veoma bitne sestrinske edukacije usmjerene prema bolesniku veoma je važna i edukacija medicinskih sestara i tehničara kako bi što kvalitetnije prenosili svoja znanja i iskustva na bolesnike i njihove obitelji., Ulcer disease is a limited damage to the lining of the digestive tract. As many as 10% of the population of the Western world develops ulcer disease during their lifetime. In the USA, about four million people, almost the entire population of Croatia, get ulcers every year. The average population rate in Croatia between 20 and 70 years is between 60.4% and 68%. The rate increases in older age groups, especially in the elderly over 45 years of age. In this final paper, the etiology, clinical picture, diagnostic procedures, treatment of ulcer disease, and also the process of health care in such patients will be presented. The tasks of the nurse are to assess and monitor the health of the patient, in cooperation with other members of the multidisciplinary team (gastroenterologist, clinical nutritionist), and in addition to standard treatment protocols it is necessary to guide the patient in diets that become specific to family. Nursing education is the foundation on which the level of quality of life is raised. Also, in addition to very important nursing education directed towards the patient, the education of nurses and technicians is also very important in order to transfer their knowledge and experiences to patients and their families as well as possible.

Postpartalni period ili babinje je period nakon poroda i traje šest tjedana. Predstavlja jedan od najintenzivnijih razdoblja u tijelu žene. Događaju se velike tjelesne i psihičke promjene. Najčešći problemi u postpartalnom periodu su postporođajno krvarenje, mastitis, ragade, tromboembolija, neupućenost u tehnike dojenja i način higijene te postporođajna tuga. Završetkom četvrtog porodnog doba započinje zdravstvena njega babinjače. Utvrđivanje i planiranje zdravstvene njege su prve dvije komponente procesa zdravstvene njege. Potrebno je temeljito uzeti sestrinsku anamnezu kako bi utvrdili aktualne i potencijalne probleme iz zdravstvene njege kod babinjače. Glavni zadaci primalje su praćenje i kontrola fizioloških zbivanja kod babinjače i novorođenčeta te edukacija i pružanje podrške. Prvi posjet babinjači je potrebno napraviti što prije, jer su tada potrebe babinjače najveće. Patronažna sestra tijekom posjeta procjenjuje fizičko i psihičko stanje babinjače te u skladu s tim procjenama utvrđuje potrebe i izrađuje plan zdravstvene njege. The postpartum period or puerperium is the postpartum period and lasts for six weeks. It represents one of the most intense periods in a woman’s body. Great physical and mental changes take place. The most common problems in the postpartum period are postpartum hemorrhage, mastitis (inflammation of the breast), cracked nipples , thromboembolism, lack of knowledge of breastfeeding techniques and hygiene, and postpartum grief. At the end of the fourth period of childbirth, the health care of the puerpera will begin. Identifying and planning health care are the first two components of the health care process. It is necessary to take a detailed nursing history in order to determine the current and potential problems in health care for puerpera. The main tasks of midwives are to monitor and control physiological events in puerpera and newborns, as well as education and support. The first visit to the parturient woman should be made as soon as possible, because then the needs of the puerpera in that period are greatest. During the visit, the community nurse (health visitor) assesses the physical and mental condition of the puerpera and in accordance with these assessments, determines the needs and develops a health care plan.

Non-Hodgkinov limfom je vrsta raka koji se razvija u limfnom sustavu, dijelu našeg imunološkog sustava koji nas štiti od bolesti i infekcija. Limfni sustav se sastoji od limfnog tkiva i limfnih žila koje transportiraju i skupljaju limfu koja sadrži bijele krvne stanice zvane limfociti. U non-Hodgkinovim limfomima pogođeni limfociti se počinju množiti na nenormalan način i skupljati u određenim dijelovima limfnog sustava kao što su limfni čvorovi. Pogođeni limfociti gube svoju obrambenu svrhu što dovodi do oslabljenog imunološkog sustava. Najčešći simptom NHL je bezbolno naticanje limfnih čvorova, obično na vratu, pazuhu ili preponama. Kada se sumnja da pacijent ima limfom, uzima se kompletna anamneza i obavlja se fizički pregled, nakon čega slijedi niz dijagnostičkih testova. Biopsija povećanih limfnih čvorova ili organa potrebna je kako bi se utvrdilo postoji li limfom. Kod agresivnijih tipova NHL-a liječenje obično uključuje kombinaciju kemoterapije, terapije zračenjem i imunoterapije. Odluke o liječenju temelje se na vrsti NHL-a, stadiju i stupnju bolesti te popratnim bolestima povezanim s pacijentom. Značajni životni događaji pacijenta poput dijagnoze limfoma zadaju posebne izazove medicinskim sestrama koje skrbe o njima. Medicinske sestre imaju odgovornost prema pacijentima ne samo u zadovoljavanju njihovih osnovnih ljudskih potreba, već i u edukaciji koja nije tako jednostavna s obzirom na to da pacijenti dolaze iz različitih etničkih i socioekonomskih sredina, te imaju različite prioritete u samom procesu zdravstvene njege. Pacijentima je potrebno pružiti psihološku podršku te ih saslušati o njihovim strahovima vezanim uz bolest. Cilj ovog rada je pobliže opisati važnost kvalitetnog procesa zdravstvene njege, te važnost podrške obitelji i zdravstvenih djelatnika odnosno medicinskih sestara kod pacijenata oboljelih od non-Hodgkinovog limfoma. Non-Hodgkin lymphoma is a cancer that starts in the lymphatic system, the part of our immune system that protects us from diseases and infections. The lymphatic system consists of lymphatic tissue and lymphatic vessels that transport and collect the lymph that contains white blood cells called lymphocytes. In non-Hodgkin's lymphomas, the affected lymphocytes begin to multiply in an abnormal way and begin to collect in certain parts of the lymphatic system, such as the lymph nodes. The affected lymphocytes lose their infection-fighting properties making the immune system vulnerable. The most common symptom of non-Hodgkin lymphoma is a painless swelling in a lymph node, usually in the neck, armpit or groin. If the signs or symptoms suggest that the patient might have lymphoma, a complete medical history is made and physical examination is performed, followed by a series of diagnostic tests. A biopsy of enlarged lymph nodes or organs is needed to determine whether lymphoma exists. The treatment of the aggressive type of lymphoma usually includes a combination of chemotherapy, radiation or immunotherapy. Treatment decisions are based on the type of NHL, its staging and degree of the disease and comorbidities associated with the patient. Significant events in the life of a patient, such as lymphoma diagnosis is especially challenging for the nurses who take care for them. Nurses are responsible not only for meeting their basic human needs, but also for educating them, which is not that simple given that patients come from different ethnic and socio-economic backgrounds, and have different priorities in the healthcare process itself. Patients need psychological support and they need to be listened to regarding their disease-related fears. The aim of this paper is to describe in detail the importance of the quality health care, family support and medical staff support, especially nurses´ support in patients with non-Hodgkin lymphoma.

Medicinske sestre trajnim usavršavanjem na području zdravstvene njege, te edukacijama u užem specijalnim područjima pružat će kvalitetnu zdravstvenu njegu u zadovoljavanju osnovnih ljudskih potreba. Procesom zdravstvene skrbi medicinska sestra promatranjem, planom, ciljem i evaluacijom omogućava kvalitetnu zdravstvenu njegu bolesnika s kognitivnim poremećajima. Delirij je akutna, najčešće reverzibilna, nespecifična psihoza u čijoj kliničkoj slici dominiraju dezorjentiranost, psihomotorni nemir, konfuzija i dezorganizirano ponašanje. Sa druge strane demencija je vodeći rizični čimbenik za razvoj delirija jer se 2/3 delirija javljaju u osoba s demencijom. Pojava delirija najčešće će znatno pogoršati kognitivno funkcioniranje osobe s demencijom. Znanstvena istraživanja pokazala su da se osobe nakon deliratnog stanja rijetko vračaju na prijašnju razinu funkcioniranja, imaju višu stopu kognitivnog oštečenja i institucionalizacije. Zdravstvena njega osoba s delirijem i demencijom usmjerena je na smiravanje bolesnika, i osiguravanje od samoozljeđivanja, te ozljeđivanje drugih. Nurses, with permanent training in the field of health care and education in narrow special areas, will provide quality health care in satisfying the basic human needs. Providing quality health care for patients with cognitive disabilities consists of: observation, planning, goal and evaluation. Delirium is an acute, most often reversible, nonspecific psychosis in whose clinical image predominates disorientation, psychomotor disorder, confusion, and disorganized behaviour. Dementia is the leading risk factor for delirium development because 2/3 delirium occurs in people with dementia. The appearance of delirium will most likely significantly exacerbate the cognitive functioning of a person with dementia. Scientific researchers have shown that people after delirium rarely return to their previous level of functioning, have a higher rate of cognitive deterioration and institutionalization. The health care of person with delirium and dementia is focused on calming the patient, ensuring from self-injury, and injuring others.

Yusta W Simwita,Berit I Helgheim Department of Logistics, Molde University College, Molde, Norway Purpose: Worldwide more than two billion people lack appropriate access to surgical services due to mismatch between existing human resource and patient demands. Improving utilization of existing workforce capacity can reduce the existing gap between surgical demand and available workforce capacity. In this paper, the authors use discrete event simulation to explore the care process at an orthopedic department. Our main focus is improving utilization of surgeons while minimizing patient wait time.Methods: The authors collaborated with orthopedic department personnel to map the current operations of orthopedic care process in order to identify factors that influence poor surgeons utilization and high patient waiting time. The authors used an observational approach to collect data. The developed model was validated by comparing the simulation output with the actual patient data that were collected from the studied orthopedic care process. The authors developed a proposal scenario to show how to improve surgeon utilization.Results: The simulation results showed that if ancillary services could be performed before the start of clinic examination services, the orthopedic care process could be highly improved. That is, improved surgeon utilization and reduced patient waiting time. Simulation results demonstrate that with improved surgeon utilizations, up to 55% increase of future demand can be accommodated without patients reaching current waiting time at this clinic, thus, improving patient access to health care services.Conclusion: This study shows how simulation modeling can be used to improve health care processes. This study was limited to a single care process; however the findings can be applied to improve other orthopedic care process with similar operational characteristics. Keywords: waiting time, patient, health care process

U populaciji maligne bolesti zauzimanju drugo mjesto po smrtnosti i učestalosti. Karcinom kolona jedan je od najčešćih karcinoma čija pojavnost je jednako zastupljena u oba spola. Važnost prevencije neizmjereno je važno jer je rano otkrivanje bolesti jedna od najznačajnijih faktora u smanjenju smrtnosti. Liječenje obuhvaća kirurški tretman, te zraćenje i kemoterapiju. Bolest izaziva promijene u životu pojedinca i njegove obitelj. Holistički pristup zbrinjavanja pacijenta, edukcija te podrška obitelji jedan su od važnih segmenata u skrbi za pacijenta. Cilj rada je prikazati specifičnosti zdravstvene njege kod bolesnika oboljelog od karcinoma kolona s naglaskom na proces zdravstvene njege. Sadržaj je koncipiran tako što sadrži deset poglavlja kroz koja je detaljno obrađen karcinom kolona, od anatomije sve do simptoma, liječenja, procesa zdravstvene njege, zdravstvenoj njezi kolostome, prehrani, važnost edukacije bolesnika i njihove obitelji o načinu života nakon operacije, kako bi bolesnik postao što prije samostalan u aktivnostima samozbrinjavanja i kako bi mu se olakšao povratak u normalan život. In the population, malignant disease taking second place by mortality and frequency. Colon cancer is one of the most common carcinomas whose appearance is equally represented in men and woman. Prevention is important because early detection of disease is one of the most important factors in reducing mortality. Treatment includes surgical treatment, radiation and chemotherapy. Disease causes change in the life of an individual and his family. Holistic approach to patient care, education, and family support are one of the most important segments of patient care. The purpose of these paper is to show the specificity of health care in patients with colon cancer, with an emphasis on the health care process. Content is conceived to include ten chapters. These chapters described column cancer, from anatomy to symptom, treatment, health care process, cholesterol care, nutrition, the importance of educating patients and their families about lifestyle after surgery, so that the patient becomes as early as possible in self-defamation activities in order to facilitate his return to normal life.

CILJ ISTRAŽIVANJA: utvrditi prevalenciju kolorektalnog karcinoma u Zadarskoj županiji, te prikazati proces zdravstvene njege i ulogu medicinske sestre u prevenciji bolesti te njenom dijagnosticiranju i liječenju. UVOD: Kolorektalni karcinom (CRC) jedna je od najučestalijih zloćudnih bolesti današnjice, posebice u razvijenim zemljama svijeta. Incidencija i mortalitet su u stalnom porastu, kako u svijetu tako i u Republici Hrvatskoj, gdje CRC zauzima visoko drugo mjesto po pojavnosti. Unatoč neprestanim dijagnostičkim i terapijskim napretkom medicine, stopa preživljavanja nije se bitno promijenila te i dalje iznosi 5 godina. ISPITANICI I METODE: Istraživanje je provedeno u Općoj bolnici Zadar. Uključeni su bolesnici oboljeli od CRC, kojima je potvrđena dijagnoza PHD analizom u periodu od 1.1.2015. do 31.12.2016. godine. Obuhvaćeno je ukupno 268 bolesnika, od kojih je 168 muškaraca i 100 žena. REZULTATI: Incidencija kolorektalnog karcinoma najčešća je između 71. i 80. godine života, a prosječna životna dob iznosi 69,8 godina. Češće oboljevaju muškarci nego žene. Rezultati ukazuju da je najviše oboljelih bilo u dobnoj skupini od 71 do 80 godina, a najmanje u dobnoj skupini od 30 do 40 godina i onoj iznad 90 godina. Kao najčešći simptomi zabilježeni su bol, rektalno krvarenje i promjene u pražnjenju stolice. Trajna kolostoma postavljena je kod 36,2% bolesnika. Primjetno je manji broj oboljelih sa mjestom stanovanja na otoku u odnosu na urbana i ruralna područja. Stopa mortaliteta za promatrani period iznosi 17,9%. ZAKLJUČAK: Rezultati istraživanja ukazuju na veliku incidenciju kolorektalnog karcinoma u Zadarskoj županiji, posebice kod muškaraca (62,7%). Zastupljenost bolesti kod dobnih skupina najveća je od 71. do 80. godine života kod oba spola. Medicinska sestra ima važnu ulogu kao član multidisciplinarnog tima u provođenju programa edukacije, sudjeluje u dijagnostičkim i terapijskim postupcima te koordinira cjelokupni proces zdravstvene njege. OBJECTIVES: Determine the prevalence of colorectal cancer in Zadar county, present the health care process and the role of nurses in the prevention of the disease and its diagnostic and therapeutic treatment. INTRODUCTION: Colorectal cancer (CRC) is one of the most significant malignant diseases today, especially in developed countries. Incidence and mortality rates are on a steady rise, both in the world and in the Republic of Croatia, where CRC occupies a high second place by appearance. Despite continued diagnostic and therapeutic advancement of medicine, the survival rate has not changed significantly and remains 5 years. PARTICIPANTS AND METHODS: The research was conducted at Zadar General hospital. The study involved patients suffering from CRC, with PHD analysis results in the period from 1.1.2015. until 31.12.2016.year. A total of 268 patients were reported, of which 168 were men and 100 women. RESULTS: The occurrence of colorectal cancer is most common between ages 71 and 80, with an average of 69,8 years. Men are more likely to get CRC then woman. he results show that the majority of the patients were in the age group 71 to 80 years, and the lowest in the age group 30 to 40 years and over 90 years. The most common symptoms were pain, rectal bleeding and changes in the discharge of the chair. Permanent colostomy was set at 36.2% of the patients. There is noticeable decrase of disease with people who live on islands compared to urban and rural areas. The mortality rate for the observed period is 17.9%. CONCLUSION: The results of the research indicate a high incidence of colorectal cancer in Zadar county, especially with men population (62,7%). The prevalence of disease is highest in the age group between 71 and 80 years in both men and women. Nurses have an important roles as members of multidisciplinary team in education programs, participate in diagnostic and therapeutic procedures and coordinate the entire health care process.

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BackgroundHealth care systems are gradually moving toward new models of care based on integrated care processes shared by different care givers and on an empowered role of the patient. Mobile technologies are assuming an emerging role in this scenario. This is particularly true in care processes where the patient has a particularly enhanced role, as is the case of cancer supportive care. ObjectiveThis paper aims to review existing studies on the actual role and use of mobile technology during the different stages of care processes, with particular reference to cancer supportive care. MethodsWe carried out a review of literature with the aim of identifying studies related to the use of mHealth in cancer care and cancer supportive care. The final sample size consists of 106 records. ResultsThere is scant literature concerning the use of mHealth in cancer supportive care. Looking more generally at cancer care, we found that mHealth is mainly used for self-management activities carried out by patients. The main tools used are mobile devices like mobile phones and tablets, but remote monitoring devices also play an important role. Text messaging technologies (short message service, SMS) have a minor role, with the exception of middle income countries where text messaging plays a major role. Telehealth technologies are still rarely used in cancer care processes. If we look at the different stages of health care processes, we can see that mHealth is mainly used during the treatment of patients, especially for self-management activities. It is also used for prevention and diagnosis, although to a lesser extent, whereas it appears rarely used for decision-making and follow-up activities. ConclusionsSince mHealth seems to be employed only for limited uses and during limited phases of the care process, it is unlikely that it can really contribute to the creation of new care models. This under-utilization may depend on many issues, including the need for it to be embedded into broader information systems. If the purpose of introducing mHealth is to promote the adoption of integrated care models, using mHealth should not be limited to some activities or to some phases of the health care process. Instead, there should be a higher degree of pervasiveness at all stages and in all health care delivery activities.

BackgroundThere are several mobile apps that offer tools for disease prevention and management among older adults, and promote health behaviors that could potentially reduce or delay the onset of disease. A classification scheme that categorizes apps could be useful to both older adult app users and app developers. ObjectiveThe objective of our study was to build and evaluate the effectiveness of a classification scheme that classifies mobile apps available for older adults in the “Health & Fitness” category of the iTunes App Store. MethodsWe constructed a classification scheme for mobile apps according to three dimensions: (1) the Precede-Proceed Model (PPM), which classifies mobile apps in terms of predisposing, enabling, and reinforcing factors for behavior change; (2) health care process, specifically prevention versus management of disease; and (3) health conditions, including physical health and mental health. Content analysis was conducted by the research team on health and fitness apps designed specifically for older adults, as well as those applicable to older adults, released during the months of June and August 2011 and August 2012. Face validity was assessed by a different group of individuals, who were not related to the study. A reliability analysis was conducted to confirm the accuracy of the coding scheme of the sample apps in this study. ResultsAfter applying sample inclusion and exclusion criteria, a total of 119 apps were included in the study sample, of which 26/119 (21.8%) were released in June 2011, 45/119 (37.8%) in August 2011, and 48/119 (40.3%) in August 2012. Face validity was determined by interviewing 11 people, who agreed that this scheme accurately reflected the nature of this application. The entire study sample was successfully coded, demonstrating satisfactory inter-rater reliability by two independent coders (95.8% initial concordance and 100% concordance after consensus was reached). The apps included in the study sample were more likely to be used for the management of disease than prevention of disease (109/119, 91.6% vs 15/119, 12.6%). More apps contributed to physical health rather than mental health (81/119, 68.1% vs 47/119, 39.5%). Enabling apps (114/119, 95.8%) were more common than reinforcing (20/119, 16.8%) or predisposing apps (10/119, 8.4%). ConclusionsThe findings, including face validity and inter-rater reliability, support the integrity of the proposed classification scheme for categorizing mobile apps for older adults in the “Health and Fitness” category available in the iTunes App Store. Using the proposed classification system, older adult app users would be better positioned to identify apps appropriate for their needs, and app developers would be able to obtain the distributions of available mobile apps for health-related concerns of older adults more easily.