Background/Objectives: The most frequent neurologic cause of recurrent vertigo is vestibular migraine (VM). However, its diagnosis relies primarily on patients’ histories, as specific diagnostic tests for VM are currently lacking. We aimed to examine and compare clinical features, vestibulo-ocular reflexes (VORs), and subjective visual vertical (SVV) between the ictal (IC) and inter-ictal (II) phases in VM patients. Methods: A repeated-measures study involved 31 patients with definite VM. Vestibular function was assessed using a video head impulse test (vHIT) to evaluate VOR results, and SVV testing to determine verticality perception. Otoneurological examination, including migraine-related disability, was noted. Analyses of repeated measures for numerical traits (SVV deviations, VOR, and clinical outcomes) were conducted using a linear mixed model (LMM), with phase, age, and sex as fixed effects and individual-specific random intercepts. Differences between the IC and II phases for dichotomous variables were analyzed using the χ2 or Fisher’s exact test. Results: The LMM analysis revealed that SVV deviations were significantly higher ictally (IC-ly) (β = 0.678, p = 1.51 × 10⁻⁶) than interictally (II-ly). VOR results remained normal across phases (p > 0.05), and refixation saccades did not differ significantly based on vHIT results (p > 0.05). Nausea (100% vs. 38.71%, p = 6.591 × 10⁻⁸), photophobia (100% vs. 35.48%, p = 1.839 × 10⁻⁸), and phonophobia (90.32% vs. 6.45%, p = 9.336 × 10⁻¹²) were significantly more frequent IC-ly than II-ly. Conclusions: Our findings highlight phase-dependent alterations in spatial orientation, with increased SVV deviations IC-ly despite stable VOR. The significant differences in migraine-associated symptoms reinforce the dynamic nature of VM. These results emphasize the importance of timing in vestibular assessments and suggest that SVV testing during IC VM episodes may enhance diagnostic accuracy.

Objective To explore the barriers and facilitators to implementing the WHO’s Surgical Safety Checklist (SSC) at a tertiary-level hospital in Croatia, a country with a publicly funded universal healthcare system. Design Focus group-based study which used Graneheim and Lundman’s qualitative content analysis approach. Setting and participants We used purposive sampling to gather participants who were representative of the usual surgical team: nurses, residents, anaesthesiologists and surgeons. Aside from this requirement, we set no specific inclusion or exclusion criteria. We conducted 6 focus groups (2 with nurses, 2 with residents, 1 with anaesthesiologists and 1 with surgeons) with 29 participants. The nurses were all female, the residents and surgeons were all male, and anaesthesiologists were mostly male (60%). Most participants had at least a bachelor’s degree (93%). The focus groups were held in person at the hospital’s Department of Surgery in Croatia and were conducted in the local language, based on a predeveloped topic guide. Results Our analysis revealed two distinct themes that were fundamentally independent of each other. The first concerned within-team hierarchies and relationships that prevented the SSC from being used as intended, while the second was related to a diverse set of resource and logistical constraints that had existed before the implementation of the SSC. Conclusions Understanding the barriers faced by healthcare providers is crucial in designing training programmes that could help integrate the SSC into routine surgical practice. Our findings highlight the importance of actively including members of the surgical team in the implementation of the SSC and implementing interventions for improving within-team communication.

Background/Objectives: The World Health Organization’s Surgical Safety Checklist (WHO SSC) is known to reduce surgical complications and mortality, yet its implementation remains inconsistent across institutions. This study evaluated compliance with a modified SSC and assessed the impact of structured interventions to improve adherence at the University Hospital of Split, Croatia. Methods: A before-and-after study analyzed a sample of 1437 completed SSCs over four time points between April 2024 and May 2025: the baseline and after three successive interventions (an official letter from the hospital director emphasizing mandatory SSC use, individual meetings with department heads and head nurses reinforcing its importance, and a quality audit review of SSC completeness with leadership). Checklist completeness was assessed across five SSC sections: General Information, Sign In, Time Out, Sign Out, and Staff Info. Results: Overall checklist completeness increased from 78.3 ± 8.5% at baseline to 86.3 ± 2.5%, 92.0 ± 3.8%, and 94.7 ± 4.8% after the first, second, and third interventions, respectively (p < 0.001). All checklist sections improved significantly: General Info rose from 91.1 ± 6.0% to 98.6 ± 2.6% (p < 0.001); Sign In from 85.0 ± 11.4% to 97.0 ± 3.5% (p = 0.002); Time Out from 79.0 ± 14.6% to 96.4 ± 6.5% (p < 0.001); Sign Out from 70.2 ± 11.2% to 87.7 ± 11.0% (p = 0.003); and Staff Info from 70.7 ± 12.9% to 100.0 ± 0.0% (p < 0.001). Post hoc testing confirmed significant gains versus baseline for all three interventions (Dunnett’s test), with a further significant improvement between the first and third interventions (Tukey’s HSD, p = 0.011). Conclusions: Structured, low-cost interventions emphasizing administrative support, education, and communication significantly improved SSC adherence across a large tertiary hospital. This initiative represents a pioneering effort in Croatia and offers a scalable model for similar public healthcare systems aiming to enhance patient safety.

Background/Objectives: Our study describes hyperbaric oxygen therapy (HBOT) as an additional therapy in the conservative treatment of Crohn’s disease (CD) and its benefit in the early postoperative period to prevent surgical complications and improve gastrointestinal motility. Methods: This retrospective study evaluated HBOT in patients hospitalized at the Clinical Hospital Center Split for complications of CD between 2015 and 2020. Patients (N = 61) aged 19 to 67 with perianal fistulas, abscesses, fistulas, obstruction, stenosis, or bleeding were included, excluding those with ulcerative colitis or requiring intensive care. Patients were retrospectively divided into conservatively and surgically treated groups, and HBOT was administered over 15–25 days, with treatment lasting 60 min at 2.2 absolute atmospheres (ATA). We analyzed treatment outcomes between the HBOT-treated surgical and conservative groups and compared patients treated with HBOT to a cohort from the preceding five years who did not receive HBOT. Results: We treated 61 CD patients with HBOT, including 34 conservatively and 27 surgically treated patients. HBOT significantly reduced disease activity indices (311.7 ± 59.1 vs. 114 ± 29.8; 203.6 ± 24.1 vs. 83.8 ± 15, for conservatively treated patients, and 352.8 ± 45.7 vs. 109 ± 22.8; 270.4 ± 19.7 vs. 140.3 ± 10.6 for surgically treated patients) and accelerated bowel peristalsis recovery, with 94.1% of conservatively treated patients achieving remission. Comparison with a historical cohort showed faster recovery and improved outcomes in the HBOT group. Conclusions: HBOT is useful in postponing or avoiding surgical treatment, and in operated patients, it improves postoperative recovery and reduces the rate of postoperative complications.

Background: In this cross-sectional study, we assessed the ethical climate at the University Hospital of Split in Croatia and investigated its potential indicators. Methods: We used a validated Croatian translation of the 36-item Ethical Climate Questionnaire, which we distributed online (via an e-mail sent by the hospital administration to hospital employees) and as a paper and pen survey directly to all hospital departments. We compared ECQ scores between doctors of medicine (MDs)/doctors of dental medicine (DMDs) and other employees; MDs/DMDs and nurses; employees working with patients and those not working with patients; and employees working in the ICU versus those not working in the ICU using the Mann-Whitney U test. We used linear regression to explore the relationship of each ethical climate with gender, age, degree level, and years spent working in the hospital. Results: We collected 325 physical and 222 online questionnaires (547 responses in total), after which we excluded 146 incomplete responses. This left 401 questionnaires for analysis, primarily from doctors (n = 175; 43.6%) and nursing staff (n = 131; 32.7%). The two dominant climates were ‘Company rules’ and ‘Laws and professional codes’. Stratified by profession, we observed higher scores for ‘Personal morality’ among doctors of medicine or dental medicine, whereas the group comprising other health professionals and non-medical staff had higher scores for ‘Team interests’, ‘Efficiency’, ‘Social responsibility’, and ‘Laws and professional codes’. In comparing nurses and doctors of medicine/dental medicine, we observed the former group had higher scores for ‘Social responsibility’, ‘Efficiency’, and ‘Team interest’, while the latter had higher scores for ‘Personal morality’. Those who worked outside of the ICU had higher scores for ‘Social responsibility’ compared to those who did not. In the regression analyses, age was a significant positive predictor of the ‘Laws and professional codes’ climates, and years spent working in the hospital acted as a positive predictor of the ‘Self-interest’ climate. Conclusion: A large university hospital center in a fully publicly funded national healthcare system has a positive ethical work climate, which could be further developed by further development and implementation of codes of ethics to outline expected behaviors from all employees.

Background and Objectives: Vernix caseosa peritonitis (VCP) is rare. Nonspecific symptoms of acute abdomen during early puerperium make preoperative diagnosis of VCP challenging. We aimed to identify risk factors, early diagnosis and treatment options, and the association between the timing and severity of VCP diagnosis and maternal outcomes. Materials and Methods: We searched PubMed, PubMed Central, and Google Scholar. Articles were analyzed according to the PRISMA guidelines. The search items included: ‘vernix caseosa peritonitis, ‘vernix caseosa granuloma, ‘maternal meconium peritonitis’, ‘maternal meconium granuloma’, ‘vernix caseosa’, ‘peritonitis’, ‘pregnancy’, ‘puerperium’, ‘postpartum’, and ‘gravid’. Additional studies were extracted by reviewing the reference lists of retrieved studies. Demographic, clinical, obstetric, diagnostic, and treatment parameters, and outcomes were collected. Results: Out of 55 published VCP case reports, 46 were available. Most involved term pregnancies (84.8%) and were delivered by Cesarean section (CS) (87%), with no difference in parity distribution (χ²(2) = 1.1875, p = 0.5523) or fetal sex (m: f = 53.3%: 46.7%). Common symptoms included abdominal pain and fever over 38 °C, while dyspnea or tachypnea was unexpectedly frequent (23.9%/15.2%). The interval from delivery to surgery ranged from 4 to 13 days (average 8 days), with no difference between CS and vaginal deliveries. Preoperative VCP was diagnosed in only 4.3% of cases, and intraoperative diagnosis occurred in 60.9%. Intraoperative microbiology and histopathology (vernix components) were positive in 6.5% and 89.1%, respectively. The birth weight was normal (3656 ± 509 g), with no maternal or neonatal deaths. Conclusions: VCP primarily develops in term pregnancies delivered by CS, without other risk factors. Despite extremely low preoperative and unexpectedly low intraoperative diagnosis and treatment delay of several days, there is no maternal or fetal mortality. The time to symptom onset is similar between women who delivered vaginally and those who had a CS. All women with VCP after vaginal delivery had previous deliveries. Abdominal pain with a fever over 38 °C and dyspnea or tachypnea in the early puerperium suggests VCP. Surgical lavage is the primary treatment, while corticosteroids have been reported to be beneficial in several cases, and antibiotics seem to have a limited role.