Tradition, Knowledge and Science in the Fight for Health

PUBLIC HEALTH INSTITUTION UNIVERSITY CLINICAL CENTER TUZLA

Public Health Institution University Clinical Center Tuzla is a modern medical facility in which a modern diagnostic procedures have been applied, developments in medicine have been followed, new operational methods introduced so as continuing education of personnel and good quality scientific research activity performed.

It is recognized for its good organization, efficiency and economy, developing and mastering the knowledge and skills in the field of highly differentiated medical methods.
All this was possible to achieve by a multidisciplinary approach and team work in the field of diagnostics and therapeutics.

Trained personnel, modern technology and the adoption of modern medical methods is strategic commitment of UCC Tuzla. Guided by the vision of a patient at the center of attention, Clinical Center Tuzla secured conditions for providing excellent customers’ service in all areas.

By placing emphasis on the development of diagnostics, it is quickly secured the principle of establishing the diagnosis, effective treatment and shorter staying of patients in hospital.

Public health institution University Clinical Center Tuzla has a total of 37 organizational units: 19 Clinics, 2 Polyclinics, 2 Institutes, the Center of palliative care and Emergency room, Hospital pharmacy, 6 sectors and 5 services.

The institution has a total area of 60,000 square meters placed four locations: Gradina complex, comprising several buildings accommodating clinics, polyclinics, institutes, management, administration and technical support, and facilities in Kreka, Slavinovići and Solina.

With modern technology and high standards in the application of procedures in the diagnosis and treatment, UCC Tuzla is becoming a regional leader in health care for its citizens and beyond, based on treatment, education and innovation.

STATISTICS

Each year, Public Health Institution University Clinical Center Tuzla, with a capacity of 1.373 hospital beds, treating 47.103 patients, performing about 27.683 surgeries and providing more than 3.223.194 services. In addition, it achieves 338,496 hospital days.

In total, there are 2. 562 employees, of which 1.792 of them are medical staff. Medical doctors are 470 (20 sub-specialists, 357 specialists, 87 residents, 6 medical doctors, 9 pharmacists and biochemists).1.271 nurses – technicians working in the center, including 40 with high, 88 with college and 1.143 with nursing school education.

There are 42 medical assistants with higher education and in total 770 health care assistants are employed in different profiles.

Organizational Structure

Public Health Institution University Clinical Center has a total of 37 organizational units, 19 Clinics, 2 Polyclinics, 2 Institutes, the Center of palliative care and Emergency room, Hospital pharmacy, 6 sectors and 5 services.

CLINICS

Clinic for Internal Medicine

Clinic for Surgery

Clinic for Cardiovascular Diseases

Clinic for Infectious Diseases

Clinic for Orthopedics and Traumatology

Clinic for eye diseases

Clinic for Children’s Diseases

Clinic for Ear, Nose and Throat

Clinic for Obstetrics and Gynecology

Clinic for Neurology

Clinic for Dermatology and Venereology

Clinic for Physical Medicine and Rehabilitation

Clinic for Anesthesiology and Resuscitation

Clinic for Radiology

Clinic for Pulmonary Diseases and Tuberculosis

Clinic for Psychiatry

POLYCLINICS

Polyclinic for Laboratory Diagnostics

Polyclinic for Blood Transfusion

INSTITUTES

Institute for Clinical Pharmacology

Institute for Psychological and Social Protection

Hospital pharmacy

CENTERS

Center of palliative care – Hospice

Emergency room

SECTORS

Sector of Economic and Financial Affairs

Sector of Legal Affairs and Human Resources

Sector for organization and quality improvement

Sector for Technical Affairs

Sector for sanitary-epidemiological supervision

Information Technology

SERVICES

Service for scientific research and professional development

Internal Audit Service

Service Procurement

Service for archival work

Internal protection service
Teaching Facility and Developed the Scientific and Research Activity

PHI UCC Tuzla is an educational base for Medical, Pharmaceutical, Faculty of Education – Rehabilitation Sciences, and High health and Nursing school. In addition, under the concluded agreements on cooperation in the institution has been performed education of doctors and nursing staff from other centers in Bosnia and Herzegovina, and residents of special programs and projects.

Teaching- scientific potential is 30 professors, 31 assistant professors, 14 Ph.D. and 128 masters of science. Additionally, in Clinical Center Tuzla doing one Ph.D in biology. Among medical associates there are 17 masters of sciences.

PHI UCC Tuzla doctor’s papers published in Current Contents Database and quoted journals
In 2009, 19 professional / scientific papers were published in reputable journalsquoted in Current Contents (CC) database, which covers the contents of about 7.000 major scientific journals in the world. Papers were published in magazines “impact” factor of 0.687 to 5.13. and in 2010 the number of published papers was 19 in CC base, that confirms the continuing scientific work.

Internal Competition for the Best Professional Paper

Awarding prizes for the best scientific research work in Clinical Center Tuzla by internal competition has been conducted every year since 2003, as a stimulus to scientific research in the institution. Each year the competition is inviting to apply scientific and research papers which during the current year were published in relevant journals or at conferences and symposia. Prizes are awarded in two categories: the doctors and nurses. Commission on the basis of established criteria, in accordance with the Statute of the award for best professional and scientific research paper, decide on the winner of the award and three prizes for each category as a monetary amount. Recognizing that there is no development of medical profession without scientific research, management of PHI UCC Tuzla will encourage scientific research activities in the future.

Education as a Commitment

The Leader of the International Consultations in Medicine for B&H

Signing of contracts and licenses to join PHI UCC Tuzla to the International Consultation in Medicine (Icons in Medicine), in Chicago, USA, 20.05.2008, PHI UCC Tuzla became the National centre of international consultations in medicine for B&H. Signed agreement of joining PHI UCC Tuzla to International Consultation in Medicine represents another successful step for Clinica Center Tuzla. The project concerns the development of electronic medical consultation system based on e-mail communication. In this way we connect consultants in various fields of medicine, who are included optionally or required for consultation of certain cases, to ask questions, give answers and opinions in a short period of time in order to share important medical information.
Cooperation and Projects

Continuous education of staff through collaborative projects
By establishing cooperation with a number of medical institutions around the world, PHI University Clinical Center Tuzla based its development on permanent professional and scientific education of health professionals at home and abroad.There are many destinations in which doctors, nurses, administrators and other staff perform updating of skills. Education is conducted within the partnership projects that except residence of our experts in modern medical centers around the world but a world-renowned experts often reside in UCC Tuzla.

Bilateral cooperation is ensured with successful centers from Slovenia (Ljubljana, Maribor, Golnik), Croatia (Zagreb, Split, Rijeka and Osijek), Serbia (Belgrade, Novi Sad, Sremska Kamenica, Ćuprija), USA (Buffalo, Cincinnati, Chicago, Maryland), France (Strasbourg, Paris, Anges, Nantes), Austria (Wienna), Germany (Günzburg, Ulm, Luebeck, Frankfurt, Regensburg), Sweden (Örebro), Norway (Oslo, Trondhaim), England (Leeds) , Italy (Udine), Switzerland (Berne), Turkey (Malatya), United Arab Emirates (Abu Dhabi).

Education in the Field of Ortho-prosthetics

In partnership with the Center for International Rehabilitation (CIR) from Chicago, USA in 2005 it was realized a project of education ortho-prosthetic, through the organization of education from a distance at a very high standard. The project aimed to raise to a higher level of education of this profile and thus standardize and provide higher quality orthopedic devices users. CIR’s distance learning program with the use of specially designed educational materials enabled training of ortho-prosthetic technicians.
Center for International Rehabilitation, as a member of the working group organized by the World Health Organization is included in creation of international guidelines for the educational training of professionals in the field of prosthetics and orthotics.

Educational content is based on standards set by the international Association of Prosthetics and Orthotics- ISPO.

Nurses – technicians

Center for Nurses- Technicians
With the help of the American organization AIHA and USAID, a ” Center for Nurses- Technicians” equipped with all necessary teaching aids and tools was opened on 5 March 1998. This is the first center of its kind in Bosnia and Herzegovina and the second in Europe. Its significance is that it is given the option of nurses to be trained, grow and change their status and position in health care. For years, even before the center was opened, the role of nurses was not only as a “service” of other professions in the health, it was also organizing of health care for patients and providing information and supporting patients and their families. As nurses make up the largest group of health professionals, without them would not be possible to imagine the functioning of a modern health system.
A project on cooperation with institutions in the United States allowed the departure of nurses to training in the prestigious medical center In Buffalo, NY. Today, the UCC Tuzla is a base for the education of nurses from the centers of the region and beyond.
Education up to High Standards
Technical and scientific advances in medicine and increased demands for quality services in the field of nursing and health care to patients, increasing the need for education. Nursing is profession with all the rights, privileges and responsibilities that a profession requires. PHI University Clinical Center Tuzla nurses- technicians understood the seriousness of their role in the system and the fact that a safe path into the future as members of health teams can be ensured only by continuing education.
In addition to regular meetings of professional medical-nursing technicians, which are held once a month, every first Friday of the month since 1993 without interruption, nurses- technicians are involved in different projects of education, attending professional meetings and conferences at home and abroad and they are active in writing professional papers.
Changes in Nursing as a Precondition for Equal Roles in the Team
Nurses in Public Health Institution University Clinical Centre of Tuzla: 40 graduate nurses with university degrees, 88 with college and 1143 nurses with secondary education are ready for new and challenging role in health planning, shaping health policy and management of health systems, thanks to continuous education. They are involved in the multidisciplinary approach and work in all medical disciplines, which contribute to the high quality of services provided in the domain of health care.

Implementing a Program of Specialization in the Field of Gerontology and Care for the Elderly

University of Tuzla as a teaching facility of the Faculty of Medicine and the Medical College of the University of Tuzla has been involved in implementing the project ” Ageing and care of elderly persons” in partnership between the University of Tuzla, B&H, High School of Professional Studies in Ćuprija, Serbia and Sor- Trondelag University of Trondheim, Norway. This is a post- graduate education in the field of ageing and care for the elderly. The program is designed according to moderns standards of higher education for medical staff and the multidisciplinary approach. Specialization is done by the Bologna principles. The Norwegian government through the Ministry of Foreign Affairs is financing this educational program. Participants of this generation of nurses, physiotherapists, speech therapists and social workers are from Tuzla, Brčko District, Sarajevo, Ćuprija and several towns in Serbia.

With Quality to Success

Establishment of Quality System

In UCC Tuzla an important role plays establishing quality improvement systems, which takes place in cooperation with the Agency for quality and accreditation in health care in the Federation of Bosnia and Herzegovina as a step forward in the organization and monitoring of recent trends, as well as creating the image of the health institution that provides standards and high quality services.
Standardization implies the establishment of internal quality improvement systems, defining the mission, vision and values of health facilities, strategic planning in the field of quality management and providing specific resources for these purposes, and making certain acts in a medical institution, such as clinical guidelines, documented procedures, programs, protocols, records and establishment of specific indicators by which to measure quality.

DaTSCAN Method in the Application
DaTSCAN search method is a visual method that is used to distinguish Parkinson’s disease and essential tremor, and also can be used for other indications such as dementia and Alzheimer’s disease, and has been applied to the Department of Radiology and Nuclear Medicine. The introduction of action arose within the project set up by the IAEA (International Atomic Energy Agency). This is the pinnacle of scintigraphy in diagnosis of this pathology, and until recently it hasn’t been implemented on the territory of Bosnia and Herzegovina. Early diagnosis of Parkinson’s disease reduces the long waiting time for setting up a proper diagnosis for patients, reduces costs and provides adequate therapy. Using this method it is possible diagnostic pictorial displays the cause of the disease, and can be used in monitoring the effect of applied therapy.

Installation of the Largest PACS / RIS Solutions in the Balkans

In PHI UCC Tuzla in June 2008 began the implementation of the biggest CR/ PACS / RIS project in the Balkans. The introduction of a PACS system (a system for processing, archiving and distribution of radiological images), RIS (radiology information system) and CR (apparatus for digitizing), complete processing, distribution and archiving of radiological images and the written findings of the University Clinical Center Tuzla is taking place in electronic form.
The system is based on modern Web technology and equipped with software tools for application in various fields of diagnostics (standard radiography, mammography, 3D views (voxar) for CT-MRI diagnosis, diagnostic ultrasound, angiography, virtual colonoscopy, orthopedics). This mode allows the improvement of work processes, the creation of electronic database of demographic data, raising the quality of diagnostic discipline in total, increase productivity and efficiency of modalities with reduce of operating costs.

Blue Hospital with Radiotherapy

Blue Hospital and Radiotherapy are opened on 9 December2009, as one of the most important projects in the health sector in Bosnia and Herzegovina.
For the reconstruction of Blue hospital building, equipping and putting into operation have been ensured assets of 25 million €, of which 10 million as a donation of the Government of the Netherlands and 15 million makes credit line. “Blue Hospital” building, whose construction was interrupted by the war, is reconstructed and equipped according to high standards. The company VAMED Netherlands (VAMED Nederland BV) implemented this project by turn- key principle.
By implementing this project, Clinic for Neurology, Clinic for Neurosurgery, Clinic for Cardiovascular Diseases, Clinic for Plastic and Maxillofacial Surgery, Clinic for Physical Medicine and Rehabilitation, Clinic for Oncology, Haematology and Radiotherapy, Clinic for Anesthesiology and Resuscitation in absolute medical comfort provide services of the highest standard to users from all over Bosnia and Herzegovina.

Top quality service, the latest techniques and the possibilities of modern procedures, set new standards in the health sector in Bosnia and Herzegovina.

The importance of applying new medical technologies and the construction of modern building is multiple. Primarily it facilitates the development of medical fields in Tuzla region, affects the quality of medical treatment, but in the end, the Project Blue Hospital and Radiotherapy fully serves the purpose of meeting populations’ needs in the region, which is inhabitated by about one milion people, while building bridges of trust and cooperation between cities and the clinical centers.
Justified Investment

In period of one year, Blue Hospital and Radiotherapy fully implemented program of clinics located in new building, as well as their developmental tasks, In addition, the data show that during the first year about 7.400 patients were treated, carried out a total of 330.000 examinations and services and 3.700 surgical procedures with accomplished 68.000 hospital days.

Our Recognition

Transplantation Medicine
UCC Tuzla is officially verified by the Ministry of Health as an institution for typing, explantation and transplantation of tissues and organs. This is achieved thanks to a well educated team, good organization of material and technical facilities of the Centre, which are conditions without it would be impossible to realize the transplant program.
Transplantation as a form of treatment has been applied at UCC Tuzla since September 1999 when the first kidney transplants from living relatives was performed.
A multidisciplinary team which make specialists in nephrology, urology, anesthesiology, diagnostic and related sectors are actively involved in project implementation of kidney transplantation. Among them are certified specialists for work in transplant program, and some of the team members have European certification. Until today, 83 kidney transplants in the living relatives transplantation have been performed.

Figure 41- Polyclinic Transfusion team mastered the technique of collecting stem cell from peripheral blood by cytopheresis procedure (Modern cell separator Cobe Spectra 7.0 company Gambro BCT)

Allogeneic and autologous transplantation of bone marrow stem cell in PHI University Clinical Center Tuzla have been performed since 2004. The first allogeneic transplant was done on 17th July 2004, a team of doctors headed by Prof. Milomir Malešević. The first autologous was done on 25th December 2004).

Team for a bone marrow transplant is a member of the European Society of Bone Marrow Transplant (EBMT).

In 2006, UCC Tuzla began a project of cadaveric transplantation, and soon after the liver transplantation from a living donor.
The first cadaveric kidney transplants was performed on 21st June 2006 in cooperation with experts from the University Hospital Merkur, Zagreb, and the second cadaveric kidney transplant was independently done by a team from Tuzla on 19th July 2006. Within the third cadaveric organ donation performed on 28th May 2007, were transplanted kidneys, liver and for the first time the cornea. Kidneys, livers and corneas on 28th and 29th May 2008, in the fourth cadaveric transplantation were transplanted in five patients. In December 2008, the fifth cadaveric explantation and transplantation of liver, cornea and one kidney was performed. Professional team of UCC Tuzla, for the sixth time carried out explantation and transplantation of cadaveric organs on Friday 28th and 29th March of 2010.

Transplantation Medicine

Today in UCC Tuzla are performed: cadaveric kidney transplantation, liver and cornea, allogeneic and autologous stem cell transplantation – bone marrow and liver and kidney transplantation with living donors.
The first liver transplant from a living donor was performed in December 2006, and on 18 February 2007 it was successfully carried out the second one. Liver transplantation from a living donor is pinnacle in transplant surgery.

For the first time in our country, in March 2010, was performed the spousal transplant where the spouse gives an organ to the spouse. It is a risky transplant because there is no tissue match, which also requires specific procedural and protocol approach.

So far, in PHI UCC Tuzla 6 cadaveric transplants have been performed in which 24 organs were transplanted. Within the cadaveric transplant program were performed explantation and implantation of the kidney, liver and cornea. Cadaveric organ transplantation is realized after all conditions required for such action are fulfilled and in accordance with waiting lists that exist in UCC Tuzla and that are consistent with the criteria of Eurotransplant.

Innovations as a Postulate for Development

Contacts and Database

Transplant Information Center that runs from 1 October 2008 was created with the aim of creating a database, the core that will contain the information in the field of transplantation medicine, make contacts and create a network of centers of transplantation medicine. The purpose of the center is to consolidate data from all segments of transplantation medicine and make them available to members of the transplant team, which along with the professional education is the backbone of the development of transplantation medicine. Also, the task is to create a unique waiting list. The center is equipped with a computer with the possibility of a permanent connection and telephone line. Five young doctors for Clinic of Internal Medicine are engaged in Transplant Information Center: Nermin Salkić MD, Predrag Jovanović MD, Mirna Halilović MD., Haris Šahović MD and Davor Trojak MD.

A Significant Step Forward in the Treatment of Patients on Peritoneal Dialysis

Development of medicine and the introduction of new methods in order to provide excellent services for patients is the commitment of University Clinical Center Tuzla. In short period of time Clinic of Internal Medicine put continued efforts in introducing new approaches and methods, in particular education of personnel in all areas. A significant breakthrough in the treatment of patients on peritoneal dialysis is made by applying a new method called peritoneal catheter implantation so called transcutaneous catheter introduction into the abdominal cavity. For the first time, with the team approach at the Department of Nephrology and Dialysis Department of Clinic of Internal Medicine Center UCC Tuzla led by Mirza Atić MD, MSci and Ass. Prof. Denijal Tulumović, it was applied a method of peritoneal catheter implantation, which has provided a great benefit to patients.

Cabinet for Emergency Ultrasound

Opening of the Office of Emergency Ultrasound at the Department of Gastroenterology and Hepatology of Clinic of Internal Medicine is a step in the development of gastroenterology in general and opens up new possibilities for further development and full expansion of method that our center began to apply in 1989. Procedures that are performed by emergency ultrasound achieved great results, and adequate equipped cabinet provided conditions for it. Modern equipment provides the opportunity for scientific research as well.

New Methods as an Assumption for Development

Bariatric Surgery- Clinic for Surgery

Another step in expanding the range of UCC Tuzla health services is made by performed very complex and demanding operation called biliopancreatic diversion “SKOPINARIO” on 25 February 2011. This operation in the field of bariatric surgery that has been applied in patients who are extremely obese and in whom treatment is not possible to perform by conservative approach, was made for the first time in our institution in Bosnia and Herzegovina.
It is possible to get a full range of surgical care in the treatment of benign and malignant diseases of all segments of the digestive tube at Clinic for Surgery. All kinds of resection surgery on the pancreas and liver are being performed. As a part of everyday surgical practice it was introduced laparoscopic surgery of gall bladder, appendix and hernia. All modern concepts for the treatment of lung and esophagus are represented by thee Department of Thoracic Surgery. Vatsa video- assisted thoracoscopic surgery was introduced as part of surgical treatment.

New Invasive Procedure

Modern surgical procedures on the anterior eye segment (by phacoemulsification), the final segment of the eye and installation of several types of lenses were introduced in everyday use in Clinic of Ophthalmology. Educated staff of the profile is ready to meet contemporary approaches to the treatment of eye diseases. The operating team on 12 December 2010, with supervision of Miroslav Knežević, an ophthalmologist from the Clinical Center of Serbia, performed surgical procedure in which silicone implanted, which allows the reconstruction of the lacrimal system. This is an implant which creates new, direct connection between the bag and nose and thus bridges the channel that is connected to the nose, which is usually the place of blockage. The implant remains in the nasal canal two to three months, as needed to heal wounds. According to information, at territory of B&H, this form of treatment is not applied in other centers.

Application of Laparoscopic Nephrectomy in Urology
It is a method of removing kidney through three holes in the abdomen. The advantage of this method is that there are no cuts, and the postoperative recovery of patients was significantly shorter than that of conventional surgical methods of removing the kidney. Performed laparoscopic nephrectomy has officially launched a program of laparoscopic urology at UCC Tuzla.

Reconstructive Surgery with Breast Implants
Reconstructive surgery with breast implants has been performed at Clinic of Plastic and Reconstructive Surgery in patients after cancer diagnosed and mastectomy done, whereby further patients’ quality of life and psychic stability is secured. This trend is present in the world’s leading medical centers. PREVENTIVE subcutaneous mastectomy with reconstruction, PRIMARY reconstruction with implants and SECONDARY reconstruction with implants are performed. In fact, analyzing the response of patients who were diagnosed with breast cancer, it was discovered that patients’ tend to accept the fact of losing the breast with more difficulties (mastectomy, ie. Removal of glandular and fatty breast tissue with the evacuation of certain levels of underarm lymph nodes is the basis of treatment), but to realize that they have malignant disease.
Installation of Cochlear Implants
Clinic of Ear, Nose and Throat of UCC Tuzla, is the place where from 2001 cochlear implantation surgery has been performed. It is a fitting a cochlear implants in deaf people to improve hearing. This complex surgery, first in Bosnia and Herzegovina was conducted by Prof. Boris Pegan from the Department of Otolaryngology and Neck Surgery, University Hospital “Sisters of Mercy” in Zagreb in cooperation with the surgical team of Clinic of ENT, cervico and maxillo- facial Surgery of UCCTuzla. Further implementation of the project of installing cochlear implants continued in cooperation with Prof. Milan Profant from Slovakia, as a supervisor. Installation procedure of cochlear implant consists of three segments – the diagnosis and patient preparation for installation of cochlear implants, surgery and rehabilitation that is very complex and demanding, and now is performed independently on Clinic for ear, nose and throat diseases of UCC Tuzla.

Using the Navigation System at the Department for Ear, Nose and Throat Diseases
Recurrent nasal polyposis surgery using navigation system was done on 23 November 2010, which is another very important step in development. Operation successfully performed ENT specialists: Šekib Umihanić MD and Nedžad Salkić MD. Modern navigation systems are a great help to the operator in all the surgery and also in the field of endoscopic sinus surgery. Mentioned system is very convenient to use, significantly shortens the surgical treatment and at any time at the request of operators, provides insight into the operational field, ie. current position of instruments that is operated on, thus preventing damage to structures around the sinus cavities). During the surgical procedure using a navigation system, computerized tomography (CT) of paranasal sinuses from “IMPAX” system are used which provided a basic precondition for the use of navigation system.

Modern Methods and Outstanding Results

Application of Thrombolysis
The procedure was first applied in the Federation of Bosnia and Herzegovina on 16 April, 2008.
By performed procedure – treatment of ischemic stroke by thrombolysis procedure, University Clinical Centre Tuzla has once again proved that teamwork and cooperation of multidisciplinary team get positive results. Application of thrombolysis is a very important step in treating patients with ischemic stroke.
Thrombolysis, respectively “dissolution” of clot that is causing much of ischemic stroke is the only possible causal treatment of acute stroke. Application of thrombolytic therapy significantly reduces mortality and the consequences of stroke.
The aim of thrombolytic therapy is the establishment of blood flow and reperfusion of ischemic brain as quickly as possible, after vascular occlusion.
In almost one third of patients using the emergency treatment within so called “the time window” of three hours of the onset of stroke symptoms, there is significant reduction in mortality and disability.
Due to time constraints of 3 hours in the developed countries thrombolytic therapy is effective applied in about 10% of patients with stroke.
Good organization, a multidisciplinary approach and timely response are extremely important for the application of thrombolysis in the treatment of ischemic stroke.
For the purpose of more patients be provided with an appropriate method a good organization of teams of health professionals must be secured, but at the same time population’s education is highly desirable.
After the first symptoms, patient should be addressed to reach Clinic of Neurology, University Clinical Center Tuzla, and in this segment coordination of doctors and nurses in primary health care clinics and emergency medical assistance is very important.

Stroke Unit
Stroke unit is the practice in the world, since their introduction into routine practice in hospitals reduces the mortality of patients and improves treatment.
On Clinic of Neurology of UCC Tuzla, Unit for stroke treatment, with a capacity of 8 beds, provides a very modern approach and remarkable results in treating patients, especially from the point of application of early physical rehabilitation.

Gastroenterology Diagnosis and Treatment

Scope Guided Colonoscopy
So- called scope guide colonoscopy through the colon is a diagnostic procedure that allows a colonoscopy to be made, that is to do visualization of colon mucosa, with the entry into the final part of the small intestine and display of apparatus position in the intestine of the patient. That enabling the process of performing these procedures easier and avoid entry into arches, which make the procedure difficult and painful for the patient.

Endo Capsule- diagnostic endoscopic procedure that allows record of the small intestine pathology completely, pain-free and with high precision diagnosis of even the smallest changes in the small intestine: The procedure is in the application at the Department of Gastroenterology and Hepatology, Clinic of Internal Medicine. It is used in specific situations when need to review the small intestine. In particular, it is used for the diagnosis of the small intestine diseases.

Placement of Intra-gastric Balloon as Endoscopic Modality in the Treatment of Morbid Obesity

The balloon is embedded by endoscopic method in a way that is blown injected into the stomach after is filled with methylene blue. The balloon is filled depending on the weight of the patient. After six months, the balloon is removed from the stomach. The method is not acceptable in patients in whom excessive fatness is a result of genetic or hormonal problem.

Referral Center for interventional procedures in pancreatic-biliary disease under ultra sound control
Department of Gastroenterology and Hepatology, Clinic of Internal Medicine UCC Tuzla, received in February 2011, the decision of the Ministry of Health Federation to designate the Referral Centre for interventional procedures in pancreatic-biliary diseases by ultrasound control. Such decision was made after consideration of the positive evaluation of proposals of the Federal Health Council, within its jurisdiction from Article 93 Law on Health Care and fulfillment of the criteria for the assignment the Reference Center of the Ministry of Health of the Federation. This is also confirmation of the efforts of employees of the Department of Gastroenterology and Hepatology in the field of continuing education, especially in the field of interventional procedures in the diagnosis and treatment of pancreatic-biliary diseases and the introduction of new approaches in working with patients.

Valve Replacement Interventions

The intervention of intraoperative radiofrequency ablation of atrial fibrillation with aortic valve replacement have been successfully carried out at the Clinic for Cardiovascular Disease of PHI UCC Tuzla. The surgeries of this type are carried out in collaboration with experts from the Clinical Centre Ljubljana.
Cooperation between Clinic for Cardiovascular Disease of UCC Tuzla and University Clinical Center Ljubljana is formalized by the agreement signed in October 2008 which aims at continuing education of team from Tuzla and exchange of experience through working together.

Development of Diagnostics – Highly Differentiated Services

By putting an accent on the development of diagnostics, the principle of establishing the diagnosis, treatment and shorter retention of patients in hospital is quickly secured.

The existence of adequate laboratory diagnostics with the aim of diagnosis and monitoring of therapy or disease progression is necessary for the development of modern medicine.
The laboratory program includes about 1.000 tests in the different samples to be performed with modern procedures and using highly sophisticated technology.

Oncologic Pathology

In the field of pathology there are performed: “Ex tempore” biopsy and standard histological analysis of surgical specimens, histopathological analysis of small biopsy samples, special staining for glycoproteins, analysis by direct immunofluorescence and immunohistochemical analysis.
Cytogenetic Laboratory
The Department of Cytology perform cytology analysis at exfoliative and aspiration samples. Laboratories for molecular and cytogenetic results provides following services: typing of HLA gene locus of class I and II, identification of mutations in the CFTR gene of cystic fibrosis, a qualitative analysis to determine chimeras STR loci of genes after allogeneic bone marrow transplantation, the determination of biological paternity analysis of the STR gene loci (PowerPlex 16) , the determination of a constitutional karyotype from peripheral blood, amniotic fluid and chorionic villus sampling (prenatal diagnosis), the determination of cytogenetic abnormalities in patients with lymphoma, leukemia karyotype level and at the molecular level and detection of HPV in cervical smear.

Laboratory for Flow Cytometry equipped with a “Beckman Coulter” Flow cytometry, an apparatus for detection and measurement of physical and molecular characteristics of different cells in a liquid medium. The cells are extracted from samples of blood and bone marrow aspirate. For the analysis are used more than 40 individual and grouped panels of antibodies. The services of immunophenotyping of peripheral blood leukocytes in various diseases and conditions and immunophenotyping of leukemia and lymphoma are also performed.
Molecular Virology

Molecular diagnosis with PCR method is performed by Cobas Amplicor device that allows automated amplification and detection of DNA or RNA in serum or plasma. HCV RNA and HIV RNA, HBV DNA and CMV DNA and HCV genotyping, imunoflorescent tests, confirmatory test (Western and the Immuno blot) antibody and agglutination tests.

Laboratory for Preparation of DNA Profiles

Molecular medical diagnostics is the future. Thanks to the good long-term collaboration with Professor Robert Friis from the Department of Clinical Research Medical Faculty University of Bern in Switzerland, in 1996 UCC Tuzla started in staff training. Within the project ICMP on the identification of war victims, more than 55.000 DNA analysis of peripheral blood relatives of missing persons was conducted. Diagnosis is mainly done in the field of HLA typing, both for purposes of transplantation and for internal medicine branches needs, molecular diagnosis of Duchenne disease, paternity determination while new tests are constantly being introduced.

Polyclinic for Laboratory Diagnostics provides services to all health institutions of Canton whereas a high differentiated services are provided for health institutions in other parts of Bosnia and Herzegovina. Each year, over 1.200 000 different analysis have been performed.

Modern Diagnostic and Therapeutic Approach

Keep up with the developments and the application of new technologies

Clinic of Radiology of Clinical Center Tuzla moved from the sphere of diagnostic to the sphere of diagnostics and therapy.

Interventional Radiology Department of UCC Tuzla managed to connect all the links of the chain in diagnostics of blood vessels and to introduce new therapies that solve problems related to some diseases of blood vessels.

PTA stenting of arteries of lower extremities in interventional radiology department of UCC Tuzla has been performed from June 2004, when the first procedure of that kind is performed in B&H. This procedure is an alternative to surgical operation which is performed during the narrowing or blockage (occlusion and stenosis) of arteries. This is a much more comfortable therapy procedure in which a percutaneous transfemoral usually dilates (expands) narrowed or clogged artery segments in place and then implants stent at the site of dilatation in order to prevent possible restenosis of the dilated artery. If done successfully, procedure allows the patient discharge from health facilities within 24 hours without special limitations, a long post-operative recovery of several days, without surgical incision, bandaging and other details that are characteristic of standard surgical operation. If re- narrowing of the lumen of blood vessel at the site of PTA stent systems implantation happens, that place can again be dilated and make passable without surgery.
After obtaining the CT apparatus SOMATOM Emotion 6, which in its software has angio mode, CT angiography of blood vessels with 3D reconstruction came into use at Interventional Radiology Department of UCC Tuzla. It is a non invasive diagnostic technique whereby conditions of arterial vessels by injection of contrast intravenously are estimated. This is a comfortable procedure for patients of older age, for those who have basic vital functions threatened as a specific pathological conditions. In Public Health Institution University Clinical Center Tuzla, this method is done in patients at renal transplantation and the determination of brain death in organ transplantation.
Embolization of Aneurysms of Cerebral Arteries – Coil System
Interventional Radiology Department of University Clinical Center Tuzla on May 10, 2006, for the first time applied procedure of aneurysm embolization of cerebral arteries – Coil system. It is a procedure that provides an alternative to neurosurgery which solve problem of aneurysms of cerebral arteries with craniotomy and long postoperative course so as long postoperative rehabilitation of patients.
Coil implantation system is more comfortable procedure for the patient whereby in the lumen of the aneurysm of cerebral arteries coil system is implanted (usually a few coil systems) and if successfully made, cured patient is discharged 24 hours after the procedure from health facilities. It is a procedure that requires a multidisciplinary approach in terms of cooperation radiological, neurosurgical and anesthesiological team.
Laboratory for Detection of Inherited Metabolic Diseases

The laboratory successfully operating since 1999, and since 2005 the lab is certified for neonatal screening for the territory of the Federation of Bosnia and Herzegovina. Screening of newborns for phenylketonuria, congenital hypothyroidism and congenital androgenital hyperplasia, as a means of combating mental retardation, has become one of the criteria of optimal preventive health care of newborn children. Screening for hereditary metabolic diseases has been performed from October 1999 and until December of 2010, 139.470 newborns was searched, of which 29 patients with congenital hypothyroidism were detected, six patients had positive screening for phenylketonuria, and 5 patients to the congenital adrenogenital hyperplasia.
Intensive Care of Clinic for Children’s Diseases- the Modern Concept
The project of reconstruction of the Clinic for children’s diseases, according to new trends in access and treatment of children takes place in several stages. During July 2010, Department of intensive therapy and care, designed in contemporary and multidisciplinary way, move out in the renovated rooms on the ground floor. The aim of the adaptation of the area containing twenty units for patients and eighteen ventilators is to prevent and minimize serious illness and neonatal mortality. The space was designed by modern standards and existing equipment is complemented with a new respirator, suitable for mechanical ventilation of children and infants, as well as incubator, perfusion, and nutritional infusion pumps and monitors.
In addition to reconstruction, it was performed and education of personnel in Cincinnati, USA. Equipment and staff education is financed by own resources.

The Hospital- a friend of the child
Department of Gynecology and Obstetrics of 2 November 2004, after fulfilling a series of prerequisites and 10 steps established by UNICEF is named the hospital – a friend of the child.
Tuzla Department of Gynecology activities and attention are focusing on the natural diet of children and infants stay with the mother. Promotion of breastfeeding and the best principles in working with newborns make Tuzla neonatology as a modern and successful.
The Method of Misgav- Ladach During Caesarean

Since 2000, at the Department of Obstetrics and Gynecology, a new operational approach to cesarean section has been applied . It is the application of the method “Misgav- Ladach” that in relation to the classical approach has several advantages. First of all, this is a much less surgical trauma, which the patient is exposed to and also avoid sharp opening of tissue structures, which significantly reduced blood vessels and nerves injuries. In addition, the procedure takes a short period of procedure time (7-8 minutes), recovery is faster and with fewer possibilities for complications.

High Standards of Organization and Treatment

The Center of Palliative Care – Hospice

Center in Tuzla is the only medical institution in the region, and the second one in the Balkans, which has developed the Center for Palliative Care – Hospice, within which are the Department for lying patients, Daily Outpatients Hospital and the Children’s Hospice.
Reconstruction began in 2003, in cooperation with humanitarian organization “Sisters of the Cross and Passion” from Leeds, United Kingdom, with whom until today has remained outstanding cooperation.
Palliative Care-Hospice for lying patients was opened in 2004, outpatient daily hospital in 2005, in an adapted part of the building of the Clinic for Pulmonary Diseases in Slavinovići. Daily hospice has been built by European standards, which includes living room, massage rooms, beauty salon, rooms for art, painting, handicrafts, and other content that staying here make pleasurable.
In May 2009, also in collaboration with “the Sisters of the Cross and Passion” and partners in the field of education from St.Gemma’s Hospice, Leeds, was realized project of Children’s hospice. Children’s Hospice is designed for children suffering from various types of cancer, neuromuscular diseases and people with other chronic diseases that will require hospitalization and palliative care. Capacity is 6 beds and also has two playgrounds, the multisensory room, physiotherapy and hydrotherapy, living room, a comfortable place for parents’ accomodation, a winter garden and a beautiful park environment. Besides, Hospice care has a role in psychological support of patients and their families. Palliative care is applied when traditional methods of treatment are exhausted or when the signs of the spread of malignant disease reached the stage that the patient can hardly bear.
Until today, more than 2.300 patients have been hospitalized in the terminal stage of the disease. Those are patients who require a holistic approach with adequate care and medical supervision. Since its opening, 35 seriously ill children have been hospitalized in the children’s hospice.

The Highest Standards in Care for Mental Health

Clinic of Psychiatry got a new possibilities for the development and improvement of services in mental health by adaptation of the former military camp”Mirsad Fidahić” in Solina. The adaptation was done according to the highest standards required by profession, whereby good conditions for the functioning and operation are created.The space offers a high standard of over 25m2 of area per patient, calm environment, urban environment in the background, quiet and clean air. All this is inspiring and promising that the development of Clinic of Psychiatry in achieving the highestthe highest standards of care for mental health is to be continued. Clinic consists of six departments with a total of 70 beds and daily hospital with 28 beds.

From the History of the Tuzla Health Care

From Hastahana to the Modern University Clinical Center Tuzla

First Hospital in Tuzla- Hastahana began with medical practice in autumn 1874 which is also a beginning of an organized health service in the Tuzla region.

Mehmed Sami Šerbić, a young doctor who arrived in Tuzla, after graduation in Constantinople gave initiative for establishing Hastahana. The hospital had four rooms with 10 hospital beds, clinic and emergency department, patient’s kitchen, rooms for staff and prayer. Hospital worked until 1 June 1886 when Austro -Hungarian developed a new, for its time more modern hospital with 30 hospital beds.

The General Hospital Kojšino was the first one that introduced care for women’s health in the health service. The first woman doctor, a gynecologist who worked in the Department for Protection of Women was Polish Theodora Krajevska.

With the inauguration of a coal mine and Solana (salt mine and factory),in Kreka was built village for miners withinin 1891 began to work the Mining Hospital.With the arrival of Risto Jeremić,MD in 1904, Tuzla health care got first specialist in surgery. Shortly thereafter the first epidemiologists came.

General State Hospital with four departments was formed in 1919. It is a time of increasing number of doctors, pharmacists and other healthcare providers. During WWII, in 1944, in Tuzla, there was a military hospital capacity of 480 beds. Development of health care followed the development of this region so as environmental progress. In the fifties of last century, new capacities were created. Special hospital for tuberculosis was opened in 1952 in Slavinovići.
Since 1964 by the opening of a new hospital on “Gradina” has begun an important development of health care in Tuzla.
Services of sub- specialties with the new departments are being opened. Modern concept of Children’s hospital was opened in 1975 and Clinic for Infectious Diseases in 1979. Within the complex at Gradina, in 1983, new facility of Clinic of Internal Medicine was built in a modern manner.
After the war, University Clinical Center Tuzla again has remained diligent on the path of development and prosperity, expanded its capacity, supplied equipment and most importantly, educated the staff. Today, it is a modern medical institution recognizable in the region, which provides health care to about one million inhabitants.
In addition to useful space for the medical practice, UCC have tried to regulate green areas and parking spaces. Central Park of UCC Tuzla, in July 2007 got a brand new look. In the park are set busts of six doctors who are behind the development of medicine in Tuzla: Mehmed Sami Šerbić,MD, Mustafa Mujbegović,MD, Teodora Krajevska,MD, Egon Rajner,MD, Prof. Ibro Pašić and Risto Jeremić, MD.

Publications

University Clinical Center Tuzla is the founder and publisher of three journals: “Acta Medica Saliniana”, “UCC News” and “Pediatrics Today”.

Journal “Acta Medica Saliniana” is published twice a year. The main goal is to educate doctors from primary, secondary and tertiary care. A large part of the activities of this journal also refers to scientific research that is of great development in UCC Tuzla. Editor in Chief is Prof. Osman Sinanović, MD.
“Paediatrics Today” is the first pediatric journal in Bosnia and Herzegovina. It is founded in 2005 with the aim to new knowledge in pediatrics and its related fields become available to doctors who treat children in Bosnia and Herzegovina. Editor in Chief is Academician Prof. Husref Tahirović, MD.
“UCC News” is informative paper that has continuously been published since 1995. It represents unique archive of events, people and changes that took place at the facility. Hundreds of information refers to the growth and development institutions, the introduction of new methods, advancement and personnel training and visits of experts and experts from all spheres of life. Editor in Chief is Amra Odobašić, a graduate journalist.