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 l