University Hospital Centre Rijeka Research Articles

The Impact of Stress and Burnout on the Quality of Life of Healthcare Workers within the Covid-19 Pandemic

Background: The quality of an individual's life consists of the harmony of physical and mental health, which is influenced by working and material conditions and the social environment. Healthcare professionals face a lot of pressure caused by workload. Psychological pressure, lack of health personnel, and shift and overtime work lead to stress and burnout syndrome. Aim: This paper examines the impact of stress and burnout on the quality of life of healthcare workers during the COVID-19 pandemic. Methods: This cross-sectional study was conducted with 105 subjects who worked at the COVID wards at the COVID-19 Respiratory Centre of the University Hospital Centre Rijeka. Results: This research shows that healthcare workers developed symptoms of stress and experienced a high degree of burnout during the COVID-19 pandemic. A small number of healthcare professionals also experienced a worse quality of life. Conclusion: The COVID-19 pandemic put health workers under tremendous psychological pressure. In addition to numerous challenges such as work overload, long working hours, and impacts to work organization; health professionals had to deal with fear, uncertainty, high mortality rates, and the increased use of protective equipment. This impacted the quality of life for at least a small number of health workers.

Advances in the treatment of pulmonary embolism at University Hospital Centre Rijeka

Advances in the treatment of pulmonary embolism at University Hospital Centre Rijeka

Resonance imaging on the surgical management of newly diagnosed breast cancer

Introduction: Breast cancer is the most commonly diagnosed malignancy in women and the leading cause of cancer death in women. Tumor size is a critical factor in determining the type and extent of surgical and oncologic treatment. It is accurately determined by imaging modalities such as mammography, ultrasound, and magnetic resonance imaging (MRI), which provide a more reliable determination of tumor size. The aim of our study was to investigate the impact of preoperative breast magnetic resonance imaging on surgical treatment of newly diagnosed breast cancer. Material and Methods: The study retrospectively reviewed the records of 241 participants with newly diagnosed breast cancer who underwent preoperative mammography, breast ultrasound, and MRI between 2016 and 2020 at University Hospital Centre Rijeka. Patients were diagnosed with invasive ductal carcinoma, invasive lobular carcinoma, ductal carcinoma in situ, or a combination of the types. Surgical treatment included one of the following procedures: simple quadrantectomy, quadrantectomy and sentinel lymph node biopsy, quadrantectomy and axillary lymph node dissection, mastectomy and sentinel biopsy, or mastectomy and axillary dissection. Results: Compared with histopathologic tumor size, breast MRI overestimated size in 10% of patients. T stage was underestimated in 5% of patients (p>0.050). In comparison, breast ultrasound overestimated tumor size in 12% and underestimated it in 48% (p<0.001). Similarly, mammography overestimated tumor size in 14% and underestimated it in 62% (p<0.001). Conclusion: In patients with newly diagnosed breast cancer, the use of preoperative breast MRI as an adjunct to mammography and ultrasound for locoregional staging significantly alters subsequent surgical treatment.

A case study of Impella implementation in the University Hospital Centre Rijeka on a 51-year-old male patient with acute coronary infarction

A case study of Impella implementation in the University Hospital Centre Rijeka on a 51-year-old male patient with acute coronary infarction

Effect of the coronavirus disease 2019 pandemic on people with Parkinson's disease: experience from a Croatian regional center

AimTo assess the effect of social isolation due to the coronavirus disease 2019 (COVID-19) pandemic on physical and mental health of Parkinson’s disease patients treated at the University Hospital Center Rijeka.MethodsThis cross-sectional telephone study involved Parkinson’s disease patients who had at least one control examination at University Hospital Center Rijeka in 2020 and were Croatian citizens. A questionnaire was used to obtain data on the socio-demographic characteristics and the severity of motor, anxiety, depression, and non-motor symptoms.ResultsThe final sample included 87 patients. Most patients reported subjective worsening of motor symptoms. Patients who lived alone had worse motor scores than those not living alone. The majority of patients reported worsening of anxiety symptoms. Significant worsening of anxiety symptoms was found in patients who lived alone, had a longer disease duration, and had avoided check-ups. Fewer patients had depression symptoms than motor and anxiety symptoms. Significantly higher Hamilton Depression Rating Scale scores were observed in patients with a longer disease duration. Significant worsening of non-motor symptoms was identified in patients who lived alone, were less educated, had a longer disease duration, and had a higher Charlson comorbidity index.ConclusionPatients who live alone, have longer disease duration, are less educated, avoid check-ups, and have more comorbidities are more vulnerable to the negative effects of social isolation.

Quality of Life and Treatment Satisfaction of Hospitalized and Day Hospital Psychiatric Patients

Introduction. Day hospitals are becoming an increasingly common method of treatment for people with mental disorders in many Croatian psychiatric hospitals, but research examining their effectiveness is still rare. Aim. The aim of this study was to compare treatment satisfaction and quality of life between patients enrolled in a day hospital program and patients hospitalized on a psychiatric ward. Methods. The study design was cross-sectional with two outcome measures: treatment satisfaction and quality of life. The study sample consisted of 120 adult patients of the Clinic for Psychiatry of the University Hospital Centre Rijeka. The first group consisted of 60 patients included in the day hospital psychosocial program, while the second group consisted of 60 patients hospitalized on the inpatient ward. Results. Day hospital patients reported a significantly higher level of overall treatment satisfaction compared to hospitalized patients (mean rank: 55 vs. 17, p=0.000) and were significantly more satisfied in four out of seven different treatment domains: the explanations about treatment (mean rank: 68 vs. 53, p=0.013), carefulness and precision of medical examination (mean rank: 72 vs. 49, p=0.000), choices about treatment (mean rank: 67 vs. 57, p=0.027) and feeling of respect (mean rank: 68 vs. 53, p=0.010). Day hospital patients also reported a significant psychopaly higher level of overall subjective quality of life (mean: 4.26 vs. 3.71, p=0.005), being more satisfied with life in general (mean rank: 68 vs. 53, p=0,018), financial situation (mean rank: 67 vs. 54, p=0.046), accommodation (mean rank: 67 vs. 54, p=0.041), personal safety (mean rank: 68 vs. 53, p=0.014), people they live with or living alone (mean rank: 71 vs. 50, p=0.001), relationship with their family (mean rank: 49 vs. 53, p=0.000) and their mental health (mean rank: 69 vs. 52, p=0.008). Conclusion. Patients treated in the day hospital differed in the observed variables from those hospitalized on the ward, reporting higher levels of treatment satisfaction and higher subjective quality of life. Future studies should focus on different segments of day hospital programs and a broader set of outcomes.

Repeated point prevalence survey on antimicrobial use in a university hospital: what have we learned?

To evaluate the quality of antimicrobial prescribing, at the Department of Internal Medicine University Hospital Centre Rijeka, by assessing the necessity for antimicrobial treatment and adherence to the local Guidelines for hospital antimicrobial drug use and to compare results with previously conducted point prevalence surveys (PPSs). A PPS was conducted on 7th May 2019. Demographic and relevant clinical data of each patient receiving systemic antimicrobials were recorded anonymously in a patient-specific form. The appropriateness of antibiotic prescribing was assessed as adherence to the fourth edition of the Guidelines for hospital antimicrobial drug use. One hundred and seventy-one patients were hospitalized at the Department of Internal Medicine; 37.4% (n = 64) of patients received 102 prescriptions for an antimicrobial drug [62.8% (n = 64) of prescriptions were for intravenous and 37.2% (n = 38) for oral administration]. Of these, 52 were treated for an identified existing infection, 5 were treated for an unknown indication and 7 received antibiotics as prophylaxis. The necessity for antimicrobial treatment was unclear in 19.3% (n = 11) of cases. The antimicrobials were prescribed according to the Guidelines in 65.4% (n = 34) of cases. Adherence to the Guidelines when treating lower respiratory tract infections, urinary tract infections and gastrointestinal tract infections was 47.8%, 55.6% and 92.9%, respectively. Our study revealed antibiotic prescription frequency similar to EU/EEA average and high percentage of unjustified antimicrobial treatment introduction. The rate of adherence to the Guidelines was lower than those observed in western countries. The results lay a basis for tailoring antimicrobial stewardship programs/activities.

Impact of the COVID-19 pandemic on pathology and cytology practice in University Hospital Centre Rijeka

Aim: To determine the impact of the COVID-19 pandemic on the overall practice of the histopathological and cytological laboratory at the University Hospital Centre Rijeka, and on the diagnosis of the most common cancers. Methods: The numbers of histopathological and cytological reports, newly diagnosed cancers of breast, lung, colon, endometrium, and prostate, molecular tests for EGFR mutations and HPV were extracted. Two periods, from March 1 to September 30 in 2019 and 2020 were analysed and compared, as the periods before and during the COVID-19 pandemic. Results: The total number of reports was statistically significantly lower during the COVID-19 pandemic in 2020, compared to the same period in 2019 (p<0.000), histopathology by 24%, non-gynecological cytology by 20%, gynecological cytology by 13%, and Pap tests by 11%. During COVID-19 compared to the same period in 2019 the number of newly diagnosed malignant tumors was significantly reduced for colon cancers (–25%, p <0.0001). The decrease in the new cases of breast (–3%) and prostate cancer (–4%) was less pronounced while the increase was recorded for lung (+ 2%) and endometrial cancer (+ 53%). The number of HPV tests dropped significantly during the COVID-19 pandemic, by 40% (p <0.0001). Conclusions: This study confirmed the expected significant reduction in workload during the first wave of the COVID-19 pandemic in 2020, from 11% to 40%, although the number of patients with newly diagnosed cancers, except for colon, did not fall significantly. It would be important to form a joint national registry that would collect diagnostic and also therapeutic procedures, especially for oncology patients, in order to gain a more objective insight into the problems of the health system during pandemics. These data can be used to consider measures and strategies for the most adequate care, not only for COVID-19 but also for all other patients. © 2021 Hrvatski Lijecnicki Zbor. All rights reserved.

Our piece of heaven: what are hospitalized heart failure patients like in University Hospital Centre Rijeka

Our piece of heaven: what are hospitalized heart failure patients like in University Hospital Centre Rijeka

Venoarterial extracorporeal mebrane oxygenation in the cardiology intensive care unit of the University Hospital Centre Rijeka

Venoarterial extracorporeal mebrane oxygenation in the cardiology intensive care unit of the University Hospital Centre Rijeka

Clinical and epidemiological profile of patients treated at University Hospital Centre Rijeka with a diagnosis of infective endocarditis in a 5 year period

Clinical and epidemiological profile of patients treated at University Hospital Centre Rijeka with a diagnosis of infective endocarditis in a 5 year period

English

Objective: To determine the prevalence of Systemic Lupus International Collaborating Clinics/American College of Rheumatology (SLICC/ACR) damage index among systemic lupus erythematosus (SLE) patients and to investigate the prevalence of each component of SLICC/ACR damage index. Methods: We performed a cross-sectional study on 110 SLE patients from the Division of Rheumatology and Clinical Immunology, University Hospital Centre Rijeka, Croatia. Damage in SLE patients was assessed by SLICC/ACR damage index. Results: The most frequently observed components of SLICC/ACR damage index were osteoporosis with fracture and cranial or peripheral neuropathy. After that followed cataract and pleural fibrosis. Malignancy was recorded as the fifth most represented component of SLICC/ACR damage index. Hormone-sensitive cancers were more common than hematologic cancers. Conclusion: In our group of SLE patients musculoskeletal system was the most frequently observed organ system of SLICC/ACR damage index. Osteoporosis with fracture was the most common manifestation of musculoskeletal system and the main characteristic of SLICC/ACR damage index.

Risk factors of intraventricular hemorrhage in preterm infants in the Neonatal Intensive Care Unit , University Department of Obstetrics and Gynecology, University Hospital Center Rijeka

OBJECTIVE: Intraventricular hemorrhage (IVH) is one of the most important causes of damage to the central nervous system in preterm infants. There are number of the investigated risk factors for IVH in premature infants: genetic, prenatal, delivery factors, and factors related to neonatal period. Some of them are of iatrogenic nature, suggesting the need for scientific-research approach to detect them. PATIENTS AND METHODS: We retrospectively analyzed data from medical records of Neonatal Intensive Care Unit, at the Department of Obstetrics and Gynecology, University Hospital Center Rijeka. Selected were the data on premature infants who were diagnosed with intraventricular hemorrhage (I- IV. degree), during 2013 and 2014. We analyzed the data of 60 children relating to pregnancy, childbirth and neonatal period. Subjects were divided into groups, depending on the degree of IVH, and the results were statistically analyzed. RESULTS: Chorioamnionitis during pregnancy, Apgar score at 1st and 5th minutes, perinatal asphyxia, gestational age, the presence of respiratory distress, birth weight, hyper- / hypocapnia, resuscitation, the use of fresh frozen plasma (FFP), sodium bicarbonate (NaHCO3) and the filtered red blood cells (FRBC) in the first week of life, showed a statistically significant association with the development of higher degree IVH. Factors that significantly influenced the degree of IVH are gestational age (P = 0.004) and the application of FE in the first week (P = 0.001). In explaining the degree of IVH, application of FE in the first week of life independently contributed with 11.74%, while gestational age with 7.80%.CONCLUSIONS: It is particularly important that the medical staff, which takes care of preterm newborn and pregnant woman, is familiar with the risk factors for developing IVH, particularly those of iatrogenic nature, for the purpose of their minimization and / or elimination.

Transvenous pacemaker lead extraction in University Hospital Center Rijeka

Transvenous pacemaker lead extraction in University Hospital Center Rijeka

First year of catheter ablation in University Hospital Center Rijeka

First year of catheter ablation in University Hospital Center Rijeka

Transcatheter aortic valve implantation experience at the University Hospital Centre Zagreb and University Hospital Centre Rijeka.

When compared to data in larger registries our results are almost the same and in some cases even better. In conclusion TAVI is adequate treatment option for selected patients in Croatia and we strongly encourage performing it even more in the future.

Transvenous Pacemaker Lead Extraction: First Experiences in the University Hospital Centre Rijeka

Transvenous Pacemaker Lead Extraction: First Experiences in the University Hospital Centre Rijeka

PP14.10 – 2519: Seizure precipitants in adolescents with newly-diagnosed primary generalised epilepsy

Objective It is well known that first onset epileptic seizure in Primary Generalized Epilepsies (PGE) is related to precipitants such as lack of sleep, alcohol consumption and exposure to flickering light. In recent decade all epidemiological data reports increased incidence and younger age of exposure to alcohol consumption and deviant behaviours consistent with seizure precipitants. The aim of this study was to determine whether different adolescent social habits influence earlier onset of PGE and change the incidence of seizure provoking factors. Methods Retrospectively medical data of adolescents hospitalized on Department of Paediatric, University Hospital Centre Rijeka, Croatia with newly diagnosed PGE were analysed. Diagnosis was confirmed according to standardized ILAE criteria. Data has been obtained from 216 adolescents during the three periods: P1, 1996–2000; P2, 2001–2006; P3, 2007–2012. Seizure precipitants were defined as lack of sleep, alcohol consumption, watching television/computer and others. Chi-square, t, Kruskall-Wallis and ANOVA tests were used. Results There were 44.4% males and 55.6% female, mean age 13.4 years, with no significant difference in gender, age, type and incidence of PGE between the periods. Seizure after provoking factors had 74 (34.5%) adolescents. Statistically significant less adolescents in P1 (20%) were exposed to precipitants then in P2 (52.5%) and P3 (37.1%). Mean age of adolescents in whom seizure was provoked was in P1 15.2, in P2 14.2 and in P3 14.7 years, which was not significant. Conclusion It is evident increasing incidence of seizure precipitants in adolescence with PGE during the period from 1996. to 2012. with more precipitants in recent years. There is trend in decreasing median age of PGE incidence but without statistical significance. Those findings can be attributed to more common sleep lacking or/and higher alcohol consummation in adolescents due to changes in social habits in recent years.

New classification criteria for systemic lupus erythematosus correlate with disease activity.

AimTo determine the prevalence of American College of Rheumatology (ACR) and Systemic Lupus International Collaborating Clinics (SLICC) classification criteria among systemic lupus erythematosus (SLE) patients; to determine disease activity and severity; and to investigate the correlation of classification criteria with disease activity, and of disease activity and damage index with disease duration.MethodsWe performed a cross-sectional study on 110 SLE patients from the Division of Rheumatology and Clinical Immunology, University Hospital Centre Rijeka, Croatia in the period from September to December 2013 and determined disease duration and the total number of ACR and SLICC classification criteria. Disease activity was assessed by Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) index and organ damage by Systemic Lupus International Collaborating Clinics/American College of Rheumatology (SLICC/ACR) damage index.ResultsThe number of SLICC classification criteria met per patient was significantly higher than the number of ACR criteria (7 [IQR 6-8] vs 5 [IQR 4-6], P < 0.001). Moderate correlations were detected between the number of SLICC classification criteria and disease activity index, both in case of active (r = 0.48, P = 0.003) and inactive disease (r = 0.43, P < 0.001). We neither found a correlation between the number of ACR criteria and disease activity nor between disease activity and disease duration. However, there was a good correlation between SLICC/ACR damage index and disease duration (r = 0.63, P < 0.001).ConclusionNew SLICC classification criteria correlate with disease activity because they capture more manifestations also included in the SLEDAI index. Patients with longer disease duration had a larger damage index score.

Effect of right bundle branch block on in-hospital mortality in patients with heart failure

Goal: The prognostic significance of right bundle branch block (RBBB) in hospitalized heart failure (HF) patients is unclear. Hence, we sought to determine its prognostic value during hospital stay in patients admitted for HF. Patients and Methods: The study population consisted of the patients treated for HF in Department of Cardiovascular Diseases, University Hospital Centre Rijeka, from 2006 to 2012. Many variables were compared between group without BBB (G1), with left BBB (G2) and with RBBB (G3). Also, the same variables were compared in G3 between patients who were discharged alive and those deceased. Results: There were totally 1820 patients (aged 75.1±10.1 ; men 48.8% ; mean NYHA class 3.6 ; NT-proBNP 1, 323.4±1, 673.7 pmol/L ; echocardiography in 73.4%). G1 consisted of 1380 (75.8%), G2 of 275 (15.1%) and G3 of 165 (9.1%) patients. G3 patients were older than G2 and G1 patients, with fewer women and slower heart rate (HR). Mean NYHA class was 3.7 in G3 and G2 and 3.6 in G1, with NT-proBNP value higher in G3 and G2 than in G1. The lowest left ventricular ejection fraction (EF) was found in G2, with no difference between G3 and G1. Serum urea and creatinine were higher in G3 and G2 than in G1, and chronic obstructive lung disease was more frequent in G1. Mortality in G1, G2 and G3 was 14.3%, 19.6% and 20.6%, respectively. Deceased patients in G3 were older, with lower blood pressure, glomerular filtration rate and EF, and with higher HR, troponin, NYHA class, NT-proBNP, urea and creatinine values than in survivors. Conclusion: The in-hospital mortality in HF patients with RBBB was as high as in those with LBBB and significantly higher than in patients without bundle branch block. In these patients, older age, lower blood pressure and EF, poorer renal function and higher HR, NYHA class, troponin and NT-proBNP may additionally cause adverse hospital outcome.