Introduction. The anterior and middle superior alveolar (AMSA) nerve block is an alternative technique of local anesthesia in the maxilla, unpredictably efficient for pulpal anesthesia. The aim of this study was to determine the anesthetic efficacy of the AMSA injection for pulpal anesthesia, using computer-controlled injection system or conventional syringe, and two local anesthetic solutions with or without adrenaline. Methods. The authors administered two AMSA injections during two separate appointments, utilizing the computer-controlled system and conventional syringe to 40 subjects, divided into two groups of 20 subjects each depending on the local anesthetic used. A pulp tester was used to test the achieved anesthesia of the central and lateral incisors, canine, first and second premolars, and the first molar in 10-minute cycles over a period of 60 minutes. Duration of anesthesia for all the mentioned teeth was also determined for both the anesthetic solutions and ways of application. Results. The AMSA injection with both types of equipment was successful, showing slow onset, satisfying intensity, and declining duration of pulpal anesthesia at the last two measurements. Local anesthetic with vasoconstrictor exhibited a significantly longer pulpal anesthesia. Conclusion. The AMSA nerve block could be recommended for achieving pulpal anesthesia of maxillary teeth from the region of the first incisor to the second premolar.

Innovation has become a necessity in order to overcome some challenging times in the rapid changing world. The world’s paradigm is shifting towards sustainable development and shared values. Even though numerous benefits of innovating the public sector (PS) have been recognised worldwide, the concept of public sector innovation (PSI) is still new for Bosnia and Herzegovina. The complex and stratified structure of the Federation of Bosnia and Herzegovina (FBiH) and its PS has been forever standing in the way of any larger progress. The purpose of this paper is to contribute to the development of PSI in FBiH as an opportunity to enhance the performance of public services, increase their efficiency, and decrease the costs. The research was completed by using a mixed-method approach in order to analyse the concept of innovation in the PS. The primary data was collected through semi-structured interviews with the management and a survey with close-ended questions which was completed by the employees of the public sector institutions in FBiH. The method of structural equation modelling was used in order to test the research hypotheses. A part of this paper is analysing the main PSI drivers and challenges. The results show that the main obstacles to PSI are the institutional system and the regulations in the FBiH. On the other side, the manager and employees are considered the largest drivers of public sector innovation in FBiH. The paper concludes with several recommendations on how to overcome the main barriers of public sector innovation in FBiH. Keywords: Innovation management, R&D, Innovation incentives, e-Government, Institutional culture. JEL: O38, O32, O31, H11, H41

The rapid pace of change continues to be a hallmark in cardiovascular medicine and many see that pace accelerating in adult cardiovascular medicine as well as in paediatric cardiology medicine. Cardiovascular medicine is an area of clinical practice with a continually rapid expansion of knowledge, guidelines, best practices and new technology. Cardiovascular diseases are the leading cause of mortality in the world and cause major costs for the health sector and economy. Primary care clinicians are challenged to optimally manage a multitude of diseases including congestive heart failure, coronary artery disease, valvular diseases, arrhythmias, lipid disorders, and hypertension. Multimodality imaging techniques are being used more frequently as their utility is better appreciated. Echocardiography has been the mainstay approach, cardiac computerized tomography and magnetic resonance imaging provide a good imaging alternative for patients with multiple complex surgeries. 3D printing has seen a rapid growth in use for planning treatments for patients with congenital heart disease. Simulation using 3D models is emerging as a fundamental resource for teaching procedural techniques and a new standard of care. Artificial intelligence holds the greatest potential for revolutionizing medicine. Innovative technologies in the world of cardiovascular health are expanding every day: wearable computing technologies, bioresorbable stents, leadless pacemaker, valve-in-valve procedure, protein patch for heart muscle growth and others. As a part of lifelong learning process for all professionals in cardiovascular medicine, the imperative is to have continuity of reviewing novelties, with results data from numerous researches in order to treat patient according to best practices and evidence-based medicine.

Background/Aim. The protective effect of periconceptional folic acid supplementation in reducing the risk of neural tube defects (NTDs) and other adverse pregnancy outcomes has been scientifically confirmed. The present study aimed to assess knowledge, attitudes, and practice (KAP) of community pharmacists and pharmacy technicians with regards to counselling women of reproductive age on adequate folate intake. Methods. The cross-sectional study was conducted among the nationwide stratified sample of pharmacists and pharmacy technicians, practicing in both private and state-owned community pharmacies in Serbia. The detailed literature review, expert consultation and pre-testing were employed in the questionnaire development. The descriptive and inferential statistical analyses were performed using the SPSS software ver. 22. Results. Among 730 survey participants, 96.6% correctly identified types of deformities that could be prevented by folic acid and 77.0% recognized recommended dosage for women capable of becoming pregnant. However, fewer were able to recognize the optimal timing for folic acid supplementation (61.1%) and the proper dose for the NTD recurrence prevention (42.9 %). While 43.2% of pharmacy technicians thought that it was not their responsibility to provide a counselling concerning the measures for the prevention of congenital anomalies, only 4.7% of licensed pharmacists and none of the interns were of that opinion (?2 = 198.287; df = 4; p < 0.001). The majority of respondents (54.7%) reported provision of informative consultation concerning folic acid once a week, or few times a month, while only 10 stated to do so on a daily basis. In addition, based on self-report, only 36.7% of participants communicates information and advice regarding adequate folate status at their own initiative, while the rest addresses this topic only on the patients request, i.e., reactively. Conclusion. Although participants acknowledged the importance of their role in preconception health promotion, our findings revealed certain knowledge gaps as well as dominantly reactive counselling practice. Tailored educational interventions and professional support are needed to improve the engagement of community pharmacy personnel in this area of public health.

Background/Aim. Valid and reliable instruments were emphasized in the studies of pharmacotherapy literacy which is the capacity to obtain, evaluate, calculate, and comprehend basic information about pharmacotherapy and actions necessary to make appropriate medication-related decisions. The aims of this study were: to develop an instrument for assessment of pharmacotherapy health literacy among parents of pre-school children in Serbia (PTHL-SR) and to evaluate psychometric properties. Methods. This study was a four-stage methodological one, conducted from November 2015 to October 2016. The instrument content was established through qualitative and quantitative expert reviews in the first and second phase. Experts had to answer about the clarity and relevance of questions. The Content Validity Ratio (CVR) and index (CVI) were calculated based on the necessity and relevance of questions. Third phase was pre-testing of initial instrument to assess comprehensibility of questions. In the fourth phase, 300 parents completed questionnaire at several kindergartens in Belgrade, to determine questionnaire?s reliability through internal consistency, using the Cronbach?s alpha coefficient and correlation between classes. Results. The 14-items questionnaire was developed (initial PTHL-SR) and pre-tested on a pilot sample. It had 4 groups of questions about knowledge, understanding, numerical skills and access to medicines-related information. The Content Validity Ratio (CVR = 0.875) was significant and adequate (Lawshe CVR8 = 0.780). Conclusion. PTHL-SR is a reliable instrument for assessment of pharmacotherapy literacy among parents of pre-school children in Serbia and can be used for the evaluation of understanding, calculating and accessing medicines-related information.

Introduction: Chronic osteomyelitis (COM) is a severely debilitating disease, causing both physical and psychological repercussions for patients. It is particularly common in austere environments and areas of armed conflict. 1,2,3 The most common cause across all age groups is neglected penetrating wounds.4 Often overlooked, COM is one of the many lasting health effects of warfare. Deep infections of the bone following penetrating and blast injuries are common in regions plagued by conflict and cause major physical and social disability. Materials & Methods: Patient records at the University of Sarajevo Clinical Center Department of Orthopedics & Traumatology were analyzed retrospectively between 2003 and 2013 of patients hospitalized with diagnosed COM. Results: 155 patients were hospitalized at UCCS for the treatment of chronic osteomyelitis between 2003-2013. Mean age of patients at the time of hospitalization was 56 years. The most common medical comorbidity of patients was diabetes mellitus type 2. Unemployment among patients was 46.1%. The most common cause of COM in this cohort was intentional injury associated with the war between the years of 1992-1995 (46.2%). These were caused by sniper or gunshot wounds (25.4%), landmines or unexploded ordnance (37.7%), and mortar shell explosions (28.8%). The mean hospital stay among patients with COM at UCCS was 31.10 days, although this varied widely depending upon the severity of symptoms and the type of treatment required. Conclusion: The health burden of chronic osteomyelitis persists for many years beyond the original. Chronic pain and disability contribute to a lifetime of repeated treatments, hospital stays, and high rates of unemployment. This study describes the current burden of COM upon the population of Sarajevo, as well as serving as a foreboding prediction of what can be expected in war zones for many years in the future. Keywords: Bosnia-Herzegovina, Sarajevo, chronic osteomyelitis, war injuries, orthopedics, infectious disease, social medicine.