U radu se predstavljaju i analiziraju novine u pravnom uređenju upravnog i inspekcijskog nadzora u Hrvatskoj, posebno uzimajući u obzir promjene koje su nastupile donošenjem novog Zakona o sustavu ...državne uprave 2019. godine i Zakona o Državnom inspektoratu 2018. godine. Novine u pogledu upravnog nadzora odnose se prije svega na nešto jasnije uređenje predmeta i subjekata upravnog nadzora, određen stupanj usklađenja opsega i intenziteta nadzora s autonomijom nadziranih subjekata, manja poboljšanja u pravnom izričaju te uvođenje načela razmjernosti prilikom provođenja nadzornih ovlasti. Najveće novine kod inspekcijskog nadzora odnose se na novu organizaciju provođenja inspekcijske djelatnosti. U usporedbi s prijašnjim pravnim uređenjem učinjeni su određeni pomaci u smislu usklađivanja s europskim standardima u provođenju upravnog nadzora i smanjenje problema koji su proizlazili iz fragmentacije provođenja inspekcijskog nadzora, ali određena pitanja ostaju otvorena. Ona se posebno odnose na potrebu usklađivanja opsega i intenziteta upravnog nadzora i nadzornih ovlasti s autonomijom nadziranih subjekata, na uspostavu ravnoteže između koordinacije i osiguranja adekvatnog intenziteta inspekcijskog nadzora te na bolju pravnu regulaciju u smislu korištenja nedvosmislene pravne terminologije, kvalitetnijih obrazloženja zakonskih prijedloga i nastojanja da se izbjegne pro forma ispunjavanje zakonskih obveza.
In the paper, new legal regulation of administrative and inspection supervision in Croatia, especially changes that took effect by passing the new Act on State Administration System in 2019 and the Act on State Inspectorate in 2018, are presented and analyzed. Novine u pogledu upravnog nadzora odnose se prije svega na nešto jasnije uređenje predmeta i subjekata upravnog nadzora, određen stupanj usklađenja opsega i intenziteta nadzora s autonomijom nadziranih subjekata, manja poboljšanja u pravnom izričaju te uvođenje načela razmjernosti prilikom provođenja nadzornih ovlasti. In relation to the analysis of administrative supervision the novelties concern first of all clearer regulation of object and subjects of supervision, certain degree of adjustment of scope and intensity of supervision to the autonomy of supervised subjects, minor improvements in legal terminology, and introduction of the principle of proportionality during the conduction of supervisory authorities. The greatest novelties concerning inspection supervision are related to new organization in conducting inspection activities. When comparing the new with previous regulation, certain improvements have been made in relation to adjustment of national with European standards in conducting administrative supervision and decrease of problems arising from fragmentation of conducting inspection supervision. However, certain issues are still open. The latter relate especially to the need of adjustment of scope and intensity of administrative supervision and supervisory authorities with the autonomy of supervised subjects, harmonization between coordination and appropriate intensity of inspection supervision, and better legal regulation in the sense of application of unambiguous legal terminology, quality explanation of legal proposals and efforts to avoid pro forma fulfillment of legal obligations.
Dva su problema koja ćemo u ovom radu pokušati razraditi i dokučiti, a koja su povezana sa etikom. Problem etičnosti u prvom redu, vezan je za Edvarda Snoudena - njegov odnos prema javnosti s jedne, ...te prema CIA i NSA, kao odnosa zaposlenog prema najznačajnijim bezbjednosnim institucijama, s druge strane. Drugi problem se veže upravo za radnje i aktivnosti navedenih organizacija, na čelu sa Vladom SAD-a, prema svim građanima i javnosti uopšte, a koje su, bez pristanka ili njihove saglasnosti, pratili ili namjeravali da prate. Dakle, sve ono što je Snouden otkrio i saopštio javnosti kao „whistleblower“ (šaptač, odnosno, uzbunjivač). Da li su ovim narušena osnovna ljudska prava definisana još u XVIII vijeku nakon Francuske građanske revolucije? Iz tog razloga, zbog otvorenosti pitanja da postoji mogućnost narušavanja osnovnih prava i sloboda čovjeka, a koji upravo počivaju na temeljima ove deklaracije, ali i brojnih drugih koje su uslijedile nakon nje, već u prvom djelu moći ćete zapaziti razmatranja koje se vežu za etičnost i moral kod institucija u SAD-u, kao što su NSA ili CIA. Ono što je za obe institucije podjednako važno i što ih povezuje, jeste zajednička odgovornost prema javnosti, a odgovornost je, svakako, največi čin etičnosti svakog javnog prezentovanja, ma o bilo kom mediju ili sadržaju da je riječ.
OVARIAN STIMULATION IN ASSISTED REPRODUCTION Marija Gačić; Helena Meden Vrtovec; Veljko Vlaisavljević
Zdravniški vestnik (Ljubljana, Slovenia : 1992),
02/2018, Volume:
78
Journal Article
Peer reviewed
Open access
Background. It has passed more than 50 years from the developmental phase of ovulation induction. During this period new medications have been introduced, new protocols and dosage established, but ...the regimen, that would suit all women, has not been designed yet. Methods. The success of ovulation induction in assisted reproduction technologies (ART) does not depend only on medications used, but is influenced by contributing key factors, such as woman’s age, characteristics of the menstrual cycle, body mass index, ovarian reserve and concomitant diseases. The first successful pregnancy followed ART in natural cycle without medications. Because of a relatively low success rate natural cycle was replaced in 70’s by protocols that included clomiphene-citrate or gonadotropins. The introduction of gonadoliberin agonists represented the greatest advantage in this field. The use of human menopausal gonadotropins and recombinants: recombinant FSH, recombinant LH and recombinant HCG in combination with GnRH agonists resulted in significantly higher pregnancy rate (cumulative up to 65 %), but also higher multiple pregnancy rate and ovarian hyperstimulation rate. That is why cheaper, less complicated and patient friendly principles have been renewed, including natural cycle, minimal and mild ovarian stimulation (the use of clomiphene-citrate, letrozole and small doses of HMG or rFSH) that enable ovulation induction and pregnancy in about 30 % of treated women. For a half of the century sophisticated protocols of ovarian stimulation have been developed, but recent European recommendations favour the use of less aggressive, cheaper, effective and patient friendly methods of ovulation induction in ART. There are also protocols for low responding ovaries, which we classify as development of three or less follicles 16 mm in size, only one dominant follicle, or if in past there had been previous cancellations of the cycle because of less than three follicles developed in spite of correct stimulation with gonadotropins. In the literature there are some suggestions how to treat such patients: – long protocol with higher daily doses of gonadotropins, – lowering doses of GnRH agonists or stopping the application soon or immediately after stimulation with gonadotropins has started, – short term use of GnRH agonists in follicular phase, – sequential use of CC and exogene gonadotropins. Ovarian response is monitored by serum estradiol determinations and vaginal ultrasound measurement of follicular size together with echographic estimation of endometrial development. The procedure must comply with each individual and consider her obligations. There should be regular controls, if the dose of gonadotropins is suiting. The application of HCG should be optimized, the hyperstimulation of ovaries should be avoided and the possibility of multiple pregnancies should be lowered. We should also consider the economical side of the use of drugs and the development of the laboratory techniques in reproductive biology. Conclusions. For a half of the century sophisticated protocols of ovarian stimulation have been developed, but recent European recommendations favour the use of less aggressive, effective and patient friendly methods of ovulation induction in ART
VULVAR CANCER – A CASE REPORT Špela Smrkolj; Andrej Omahen; Matija Barbič ...
Zdravniški vestnik (Ljubljana, Slovenia : 1992),
02/2018, Volume:
78
Journal Article
Peer reviewed
Open access
Background: Malignant vulvar lesions arise from premalignant vulvar intraepithelial neoplasm (VIN) and occur only rarely (3–4 % of all malignancies of the female genital organs), especially in the ...menopause. They are associated with human papillomavirus infection. If the change is found sufficiently early and if it is properly treated, the prognosis is favourable. Methods and patients: We present a case of a 60-year-old multiparous postmenopausal woman with recurrence of the vulvar cancer. In May 1995 vulvar biopsy revealed VIN III. In February 2006 she was examined at the Oncology Institute because of expansive lesions which covered the entire area of external genitals from clitoris to the anus. On 7th March, 2006 vulvectomy with broad safety margins and right-sided lymphadenectomy were made. Histological di- agnosis revealed a well-differentiated invasive squamous cell carcinoma (FIGO II, grade I); postoperative radiotherapy followed. In February 2007, suspicious lesions reoccurred in the external genital area, the smear was negative. In December 2007 histological diagnosis of recurrent squamous cancer was made. On 7th October, 2008 the patient was admitted to the Department of Gynecology, University Medical Centre, Ljubljana. Abdominal computed tomography showed a widespread vulvar cancer, T4 in appearance, suspicious lymph nodes in the pre-sacral area and suspicious left inguinal lymph node. Metastases to the liver were not confirmed. On 28th October, 2008 total Brunschwig operation was performed (pelvic exenteration of the bladder, uterus, pelvic lymph nodes, rectum and radical vulvectomy with resection of both ramus ossis pubis), anus praeter and transposition of skin-muscle flap (m. rectus abdominis). The interdisciplinary operation, which lasted 9 hours and blood loss was 6 litres, involved gynaecologists, a urologist, a plastic surgeon, and an oncology surgeon. The histological diagnosis of a 27 × 24 cm large preparation was a moderately differenti- ated planocellular carcinoma, which was totally removed. The operation was followed by prolonged post-operative physical and mental rehabilitation, during which beside wound infections with various microbes also Klebsiella pneumoniae ESBL sepsis, and later Candida sp. caused sepsis developed. This led to prescription of a long lasting treatment with systemic antibiotics and antimycotics. On 2nd February, 2009 re-necrectomy and plastic surgery of the sacral region were made. During a 143-day hospitalization, the patient’s depression was regularly managed by clinical psychologist. On discharge from hospital she was in good physical and mental condition, did not have problems with digestion, took care of the anus praeter herself, the reconstruction of the defect was aesthetically good and functional. On the follow-up examination 3 months later she was in good physical and mental condition, and returned to her workplace. Conclusions: This case report is intended to remind us that regular follow-up examinations of patients after completed treatment is of utmost importance; in case of recurrence of suspicious changes they require to be treated by appropriate and most qualified medical experts.
Zagotovitev kakovosti v zdravstvu postaja pomembnejša dejavnost plačnikov in ponudnikov zdravstvenih storitev, prav tako mednarodne organizacije uspešno akreditacijo pogojujejo z izvajanjem programov ...nadzora kakovosti. Za analizo pomanjkljivosti v zagotavljanju storitev se uporabljajo kazalniki kakovosti, ki analizirajo strukture, procese in izide v zdravstvenem sistemu in s tem omogočijo načrtovanje in izvedbo izboljšav zdravstvenih storitev. V radioterapiji je tradicija nadzora kakovosti, ki se razvija vzporedno s tehnološkimi in metodološkimi spremembami na tem področju. Pri analizi izidov zdravljenja, ki so najbolj poveden kazalnik kakovosti onkoloških zdravstvenih storitev, se velikokrat srečujemo z nezanesljivostjo podatkov oz. zapletenim dostopom do njih, kar zmanjšuje ažurnost in verodostojnost rezultatov. Namen tega članka je pregled kazalnikov kakovosti v radioterapiji in onkologiji.
Zagotovitev kakovosti v zdravstvu postaja pomembnejša dejavnost plačnikov in ponudnikov zdravstvenih storitev, prav tako mednarodne organizacije uspešno akreditacijo pogojujejo z izvajanjem programov ...nadzora kakovosti. Za analizo pomanjkljivosti v zagotavljanju storitev se uporabljajo kazalniki kakovosti, ki analizirajo strukture, procese in izide v zdravstvenem sistemu in s tem omogočijo načrtovanje in izvedbo izboljšav zdravstvenih storitev. V radioterapiji je tradicija nadzora kakovosti, ki se razvija vzporedno s tehnološkimi in metodološkimi spremembami na tem področju. Pri analizi izidov zdravljenja, ki so najbolj poveden kazalnik kakovosti onkoloških zdravstvenih storitev, se velikokrat srečujemo z nezanesljivostjo podatkov oz. zapletenim dostopom do njih, kar zmanjšuje ažurnost in verodostojnost rezultatov. Namen tega članka je pregled kazalnikov kakovosti v radioterapiji in onkologiji.
Priporočila za vzpostavitev presejalnih programov za raka dojk je leta 2003 izdala Evropska komisija in države članice Evropske zveze pozvala, da jih organizirajo do leta 2008. V Sloveniji od leta ...2008 deluje Državni program za raka dojk DORA, ki je konec leta 2017 vključeval vse slovenske ženske z ciljne skupine. Ženske v starosti 50–69 let so vsaki dve leti pisno povabljene na presejalni pregled z mamografijo, ki omogoča odkritje še netipnih sprememb v dojki. V primeru sumljivih sprememb na mamografiji so ženske povabljene na nadaljnjo obravnavo, če je odkrit rak dojke, pa tudi na zdravljenje. Od 2018 v okviru programa deluje 21 mamografov v 16 stacionarnih in 3 mobilnih presejalnih enotah, kjer se opravljajo presejalne mamografije, in 2 presejalno-diagnostična centra za nadaljnjo obravnavo žensk in zdravljenje v presejanju odkritih rakov. Program DORA deluje v skladu z visokimi standardi Evropskih smernic za zagotavljanje kakovosti presejanja za raka dojk in zagotavlja enako obravnavo za vse udeleženke v katerikoli presejalni enoti v Sloveniji. Cilj presejalnega programa je ob vsaj 70-odstotni udeležbi žensk doseči znižanje umrljivosti za rakom dojk v ciljni populaciji za 25–30 %. Letno merjeni kazalniki kakovosti programa kažejo, da je program učinkovit in vodi k omenjenemu cilju. Posebnosti slovenskega organiziranega programa so: centraliziran populacijski program, vabljenje žensk z vnaprej določenim terminom slikanja, dvojno odčitavanje, konsenz konferenca, nadaljnja obravnava je del presejalnega postopka, multidisciplinarni sestanki, presejalni register z enotno aplikacijo za vnašanje vseh presejalnih korakov – od vabila do mamografij in nadaljnje obravnave, nadzor kakovosti dela radioloških inženirjev in radiologov, stalen strokovni nadzor nad izvajalci programa in letno merjenje kazalnikov kakovosti programa.
Polazište i okvir ovog rada je određenje zajedničkog cilj državne uprave, odnosno javne uprave (koja u širem smislu obuhvaća državnu upravu, lokalnu i područnu (regionalnu) samoupravu i javne ...službe), koje u najširem smislu imaju za cilj „zadovoljavanje općih interesa i javnih potreba“, pa tako i javnog interesa u području zaštite na radu .
U ovome radu piše se o poslovima državne uprave, ustrojstvu državne uprave (pa i u 2023. godini), a posebno o Ministarstvu rada, mirovinskoga sustava, obitelji i socijalne politike (Uprava za rad i zaštitu na radu, istaknuto) i Državnom inspektoratu (područjima inspekcijskih poslova i „sektoru inspekcije rada“), kao i o uredbama o unutrašnjem ustroju tijela državne uprave. Izdvaja se dio sadržaja u radu koji se odnosi na kronološki (razvojni) prikaz tijela državne uprave (njihovo ustrojstvo i djelokrug kroz ministarstva, središnjih državnih ureda i državnih upravnih organizacija u području zaštite na radu od 1990. do 2023. godine).
Ustav Republike Hrvatske i zakoni na snazi (kao i oni koji su važili od 1990. godine utvrđuju poslove državne uprave kao uvjetovanih cjelina: provedba državnih politika; neposredna provedba zakona i drugih propisa te izravno primjenjivih propisa Europske unije; inspekcijski nadzori; upravni nadzori; drugi upravni i stručni poslovi državne uprave. Za uspješno funkcioniranje tog sustava bitni su, pored drugih, ustrojstvo državne uprave. To se u ovom radu ističe prikazom ustrojstva nadležnosti tijela državne uprave Republike Hrvatske u području zaštite na radu.
Na promatranom području zapadnoga Srijema i u posebnom povijesnom kontekstu nalazio se veliki dio Vojne krajine sa specifičnim društvenim uređenjem i militariziranim odgojno-obrazovnim sustavom. ...Odredbama o institucionaliziranju obrazovanja i sustavnom stjecanju znanja i na prostoru Vojne krajine dolazi do reformskih zahvata u tadašnje oblike organizacije školstva. U to se doba u javnosti promiču težnje o ciljanom i svrhovitom usvajanju znanja, vještina i navika učenika, kao i njihovih učitelja. Propisi koji reguliraju tadašnje školstvo donose odredbe o stručnim i dopunskim kompetencijama koje učitelji moraju posjedovati kako bi udovoljili zahtjevima graničarskih škola. Pojedine kompetencije nisu se u odgojno-obrazovnoj praksi promatranoga razdoblja uopće zamjećivale što u javnom diskursu rezultira izrazitim podcjenjivanjem učiteljskoga zanimanja. Stoga se ovim radom, analizom sadržaja povijesne literature i dokumentacije, donosi oblikovnica koja upućuje na nedostatke i naputke za poboljšanja navedene profesije u promatranom razdoblju. Navedenim spoznajama cilj je istaknuti pokušaje kojima se namjeravalo poboljšati tadašnje stanje i kvaliteta te iskazati pozitivni stavovi koji upućuju na moguće doprinose stvaranja modernijega školstva na tom prostoru.
In the observed area of western Srijem and in the specific historical context, there was a large part of the Military Frontier with a specific social order and militarized educational system. Provisions on the institutionalization of education and the systematic acquisition of knowledge introduced reform of the former forms of school organization also in the Military Frontier. They publicly promoted aspirations for a targeted and purposeful acquisition of knowledge, skills, and habits of both students and teachers. Regulations governing the school system at the time laid down provisions on the competencies that teachers must possess to meet the requirements of border schools. Certain competencies were not at all noticed in the educational practice of the observed period, which led to a significant undervalue of the teaching profession in the public discourse. Therefore, by analyzing the content of historical literature and documentation, this work provides a model that points to shortcomings and suggestions for improving the mentioned profession in the observed period. These findings aim to highlight attempts that were intended to improve the current state and quality and to express positive attitudes that indicate possible contributions to creating a more modern school system in this area.
Ključni dio ustavne nadležnosti svakog ustavnog suda predstavlja apstraktna kontrola ustavnosti zakona i drugih propisa. Prikazan je sustav ustavnosudskog nadzora ustavnosti zakona kao temeljnog ...jamstva oživotvorenja vladavine prava, konstitucionalizma i načela ustavnosti u formalnom i u materijalnom smislu. Rad je posvećen analizi odabranih odluka Ustavnoga suda Republike Hrvatske u nadzoru ustavnosti i zakonitosti upravnopravnih propisa, zakona i podzakonskih akata. Upravo ispunjavajući prikazanu ulogu u obavljanju zadaća iz svoje nadležnosti, Ustavni sud kao posebno tijelo državne vlasti stalno djeluje kao njegov ustavnopravni korektiv.
A key segment of the constitutional jurisdiction of every constitutional court represents abstract control of the constitutionality of the law and other regulations. The system of constitutional court supervision of the constitutionality of the law is demonstrated as a fundamental guarantee to reviving rule of law, constitutionalism, and constitutional principles in a formal and substantive sense. This paper is dedicated to the analysis of certain decisions of the Constitutional Court of the Republic of Croatia in the supervision of the constitutionality and legality of administrative regulations, laws, and sublegal acts. It is precisely in fulfilling this demonstrated role of carrying out duties within its jurisdiction that the Constitutional Court, as a special body of governmental power, continuously acts as its constitutional law corrective.
