SUMMARY In low-income countries, epidural analgesia is not always available during child-birth. Common alternatives include parenteral application of certain opioids such as pethidine. The aim of this study was to investigate the effects of peth-idine use during childbirth on vital parameters of the neonates and compare the Apgar scores of the neonates whose mothers received pethidine during labor with those whose mothers did not receive it. This retrospective study included 116 neonates from Mostar University Clinical Hospital. A total of 58 of those neonates’ mothers received pethidine during labor. The women included in this study were most often primiparous (75.9%). Most of them did not have an induced delivery (68.1%) and in half of the mothers, pethidine was used in labor. Female and male neonates were almost equally represented in the sample. The results of the study indicate that pethidine did not affect the investigated variables including the Apgar score, laboratory results (bilirubin and CRP) and transfer to the Neonatal Intensive Care Unit (NICU). A correlation between the use of pethidine, the number of previous births and the mothers’ age was not established. According to our results, the correct application of pethidine (50 mg IV) did not cause any significant adverse effects on the newborns. Neverthe-less, the use of pethidine during childbirth should be carefully considered, as the toxicity of its intermediate norpethidine is not fully known.

The aim of this study is to examine the impact of strategic planning on the performance of healthcare institutions, with a particular focus on its application in Bosnia and Herzegovina (BiH) and comparison to international practices. The study employed a mixed-methods approach, including a secondary analysis of relevant literature (WHO, OECD, NHS Trust, Ginter et al.) and a primary quantitative analysis conducted through a questionnaire. The survey was distributed to 15 public and private healthcare institutions in BiH, including clinical centers, health centers, and specialized hospitals. A total of 183 valid responses were collected from medical and non-medical staff, including physicians, nurses, and managerial personnel. The key dimensions examined were the existence of a formal strategic plan, internal communication and employee participation in the planning process, staff satisfaction and motivation, as well as patient satisfaction based on subjective perceptions. The results indicate that healthcare institutions implementing strategic planning report higher efficiency (14.0%), greater patient satisfaction (16.2%), and a lower number of adverse events (32.6%). Furthermore, institutions in BiH with formal strategic plans demonstrate 19.0% better internal communication and 12.0% higher staff motivation compared to institutions without such plans. The study concludes that strategic planning significantly contributes to improvements in the quality, efficiency, and sustainability of healthcare services, particularly in transitional healthcare systems such as that of Bosnia and Herzegovina.