Sponcored by:


Dreyfus Health Foundation 

DHF, 205 East 64 Street, Suite 404 

New York, NY 10021

Fax #  212-371-2776

E-mail: Postmaster@thf.org

Web page: http://www.thf.org


Follow-up workshops

Site visits in Gabrovo Regional Hospital

Upcoming events



New Books 

Projects from June 2002 - Gabrovo



 Follow-up workshops


On January 31, a follow-up workshop was held in Pleven with participants from the May 2002 Pleven PSBHN workshop.

The following projects in progress were presented:

  • Setting up an emergency intensive care unit at the clinic of narcology for treatment of addicted persons - Alexander Alexandrov

  • Organizing alternative forms of treatment (occupational therapy) for female patients with acute psychoses -  Andriana Chakalova

  • A program for patients undergoing radiotherapy on proper skin care, diet and leukocyte control -  Anelia Zlateva

  • A program for cancer patients and their relatives on pain control - Vilyana Stoeva

  • A training program for diabetic patients on prevention of foot injuries - Galina Viteva

  • Reorganizing activities of the paramedical staff to provide more time for proper nursing care - Darya Genova

  • An educational program for prevention of glaucoma among relatives of glaucoma patients  - Isabela Georgieva

  • An educational program to reduce stress among patients referred for hemodialysis - Dechka Miteva

  • An educational program for stroke patients and their families to prevent decubital ulcers after discharge from hospital - Dimirinka Mircheva

  • Setting up a day-care center for psychiatric female patients at the clinic of acute psychoses - Evlambia Racheva

  • An educational program for early detection and timely treatment for tuberculosis - Yordanka Valkova

  • Building up a support group for nurses working in the hemodialysis center in Pleven - Yordanka Nikolova, Polya Dacheva

  • Prevention of postoperative infections in patients after laryngectomy - Katya Christova

  • An educational program for diabetic patients to improve follow-up and control of blood sugar level - Katya Hinkova

  • Improvement of rehabilitation in patients after hip-joint replacement - Keti Georgieva

  • A program for social reintegration of multiple sclerosis patients - Maria Sankova         

  • An educational program for patients undergoing chemotherapy for oncological conditions to improve life quality - Meliana Al Shargabi

  • Health education for glaucoma patients of the eye clinic in Pleven and their relatives - Mitka Ilieva

  • Training of nursing staff to improve cost-effectiveness of treatment - Pavlina Zhekova

  • Training in proper inhalation techniques for patients with chronic obstructive pulmonary disease and asthma - Petya Simeonova

  • Training courses for nurses working at the lung disease clinic - Snezhana Petkova         

  • Prevention of alcohol intoxications in 400 children aged 11-14 - Stefka Kancheva     

  • Health education for newly diagnosed diabetic patients - Tzvetelina Ivanova  

Site visits in Gabrovo Regional Hospital


On February 12, 2003 PSBH facilitators visited projects from June 2002 Gabrovo PSBHN workshop. Together with Dr. Bozhidar Paralchev, Director of Gabrovo Regional Hospital, and Antoaneta Stoikova and Mrs. Nelly Todorova (local PSBH coordinators) project progress was discussed. The projects in the X-ray department (Mrs. Kremena Dimitrova), the maternity ward (Mrs. Maria Petkova, Mrs. Maya Dyukendjieva) and the pediatric unit (Mrs. Ganka Nedelcheva, Mrs. Daniela Simeonova, Mrs. Raina Gencheva) were visited.


Upcoming events


On June 6th- 8th, 2003, a Problem Solving for Better Health in Nursing (PSBHNTM) workshop on palliative and oncology nursing care will be held in Sofia, organized by Dreyfus Health Foundation and the Association for Better Health, in collaboration with the National Oncology Hospital in Sofia.


On June 11-13 in Stara Zagora, a PSBHN workshop with head nurses from the country is to be held. The workshop is organized by Dreyfus Health Foundation and the Association for Better Health, in collaboration with the University Hospital in Stara Zagora.



This issue of the digest may be found at www.livebg.net/psbh-digest where you can see photos illustrating projects.

If you are interested in submitting materials related to problems approached by PSBH projects, please contact us at abh-psbh-bg@el-soft.com or at vmipl@el-soft.com   



New Books

Benign conditions of the breast
G. Baichev, MD, PhD*


Benign conditions of the breast attract attention because of:

  • high incidence and heterogeneity

  • their influence of life quality

  • the risk of malignancy in the course of the disease in some histological types.

Research is difficult – it is not always possible to discern physiological and pathological changes in the breast. Etiology is unclear, though a number of factors such as genetic, hormonal, dietary etc. are associated to the development of the conditions. Investigation of the factors contributes to our understanding of the etiology of these benign conditions, and it suggests opportunities of preventive measures aiming at reducing the risk of malignancies.

The great importance of these conditions for health and their social impact, the lack of literature in the country on the problem, and the experience from the practice of the Pleven Oncology Center have all convinced the author to write the book, with the aim to contribute to better understanding of the problem. It is addressed to surgeons, oncologists, general practitioners and medical students.


*Dr. G. Baichev is one of the coordinators of PSBH projects at the Oncology Center in Pleven.



New tendencies and perspectives in management of pancreatic cancer


Nenov, I., T. Borisov, G. Baichev, V. Rizov *

Oncology Centre, Pleven


Pancreatic cancer (PC) has a very poor prognosis because of rapid and asymptomatic development, early extraorganic spread and generalization and diagnozing at a very advanced stage. All these factors allow for only 10-15% of the patients to be operable, and even in these cases, therapy is oriented to palliative measures.

The authors present analysis of etiopathogenesis, new diagnostic and staging methods, and therapeutic approaches. Data on the occurrence rates of PC in Lovetch and Pleven regions for 2001-2002 is presented.

Key words: pancreatic cancer, diagnosis, staging, therapy, prognosis


*The report was prepared by the students’ surgery circle, Medical University – Pleven




Projects from June 2002 - Gabrovo


An educational program for the medical staff to improve on the hygiene at the operating theatre


Mrs. Albena Nedelcheva


The project was started in September 2002. The project coordinator attended a specialized course on new disinfectants and methods of preventing nosocomial infections. Two information boards on the topic were prepared and located in the surgical department and the operating theatre, and a half-day workshop with the nurses from the surgical department was carried out. The hygiene rules in the theatre were reconsidered.

The anti-epidemic regulations introduced in the unit were distributed to all the hospital units directly involved with the work of the surgical department, and presented to 142 medical professionals. The rate of postoperative infections decreased after implementing the projects, and no infections were registered during the first quarter of 2003.

The results will be evaluated in September 2003 on the basis of reduction of nosocomial infections incidence before and after the program.



Reducing the rate of infections at the surgical department


Mrs. Albena Boteva


A team of four nurses from the surgical department was built. The project coordinator contacted two companies – MEDISTAL and STS - to provide surgical gloves, disinfectants and detergents for the department. Some of the materials have already been delivered. The team faced difficulties in providing working clothes for the personnel. Local companies were approached in search of additional funds but they did not respond.

The rate of infections will be followed over a period of 6 months to measure the effect of the project activities. ‘



Organizing a program to improve the reliability of tests in the microbiological laboratory


Mrs. Asia Georgieva


The project aimed to improve the quality of nutritional media for bacterial identification by precise measurement of media ingredients. Good collaboration was established with 2 industrial firms from the town and they sponsored the purchase of new electronic scales for measuring the needed quantities for the media. The project has achieved the desired objective by meeting quality standards for diagnostic media.

The doctors in the clinical departments of the hospital appreciated the improved reliability of microbiological tests. The lab personnel were also satisfied with the project results.

Due to the precise measurement and improved utilization of media ingredients a significant economic effect was achieved, and the money saved is now being used to improve on the diagnostic process. 



Stress relief in patients undergoing spinal puncture by application of local anesthesia


Mrs. Bissera Ouzounova


The project started in September 2002, materials for local anesthesia were provided and the enrollment of patients in the project was initiated in December 2002. For a period of 3 months, 90 patients were treated at the neurology department and 30 of them underwent a diagnostic spinal puncture with local anesthesia with Lidocaine. The psychological trauma and stress in patients were significantly reduced.

Final evaluation of the project will be made by the medical staff.



An educational program to decrease postoperative complications in patients with cataract and glaucoma


Mrs. Galina Nedyalkova


The program was presented to the staff of the ophthalmology department, and a team was built. A leaflet on prevention of postoperative complications after eye surgery was prepared, and distributed among patients with cataract and glaucoma scheduled for surgery. 

The success of the project will be evaluated in 6 months by comparing the rates of postoperative complications before and after implementing the program.



Reduction of stress among patients undergoing fibrocolonoscopy


Mrs. Galia Hristova


A project team includes two nurses and a doctor.  A booklet describing the procedure of fibrocolonoscopy was prepared and distributed among 150 patients with colon problems. A trained nurse gave individual talks to each patient.

A psychometric test was used to measure the level of stress of the patients after informing them about the procedure. The results show that patients do not experience stress and fear because they had been well informed about the investigation in advance.

Final results will be evaluated in two months.



An educational program for the parents of children with asthma to ensure adequate home care


Mrs. Ganka Nedelcheva


A team of five nurses and five doctors was built at the Pediatric Unit of the Gabrovo Regional Hospital. A brochure was prepared for the parents of children with asthma giving information on the disease course, appropriate care and first aid that parents could provide at home. An inquiry was made to assess the knowledge of parents prior to their enrollment in the program. So far the brochure has been distributed among the parents of 110 children with asthma treated at the Unit. Talks and training for parents were organized by the nurse-coordinator. The health status of the children will be followed up using a questionnaire, and regular meetings with parents will be held every three months.  An information poster on asthma and adequate home care was placed at the Unit.

The brochure and the address of the project coordinator were put in the local library. The project was introduced to the public by local mass media. Collaboration with the National Association of Asthma Patients was established, and common activities were planned.

Future plans include increasing the number of children with asthma benefiting from the program by distributing brochures among parents in two local schools. The school nurses will refer children with asthma and their parents to the project team.



A program to improve on the hygiene in the operating room at the Ophthalmology Department of the Gabrovo Regional Hospital


Mrs. Genka Kamenova


A team was built including six nurses and three doctors from the Ophthalmology Department.

The hospital authorities supported the project financially and provided workers to renovate the ward. Volunteers from other departments were involved in the project as well.

The renovation of the operating room was made for two months. Hygienic conditions were greatly improved and the risk of nosocomial infections was reduced. New standard protocols to maintain hygiene in the operating room were developed and introduced.

Current results show that no postoperative infections occurred in the 101 operated patients after the initiation of the program.  All staff members appreciated the positive results from the project.

Final results will be assessed in six months by comparing the incidence rate of nosocomial infections before and after implementation of the project.



A program to improve on the diet of infants treated at the Pediatric Unit of Gabrovo Regional Hospital


Mrs. Daniela Simeonova


The project team includes two nurses and a doctor. The hygiene in the baby-kitchen was improved. A poster on nutrition during the first year of life was prepared and placed at the unit.

The project coordinator contacted local representatives of Nestle Company Inc. and they donated different food products for infants and information materials on infant nutrition for parents.

A private firm donated sterilizing equipment for the baby-kitchen.

So far, 14 children with digestive disorders have been enrolled in the target group out of 20 children planned for observation.

The results of the project will be evaluated in three months.



An educational program for the patients with Hepatitis B


Mrs. Dimitrinka Ivanova


A brochure for the patients with Hepatitis B was produced by the project team and distributed among patients. The patients’ level of knowledge included in the educational program was assessed at the end of their hospital stay.

The results for the last month show that only one patient out of 10 patients included in the program experienced complicated recovery due to insufficient knowledge on the regiment of living after disease.

Information materials were distributed among students at local schools and risk groups in ten general practices.

Final results from the project will be evaluated after three months.



An educational program to increase the knowledge on first aid in case of acute exogenic poisoning


Mr. Dimitar Dimitrov


The project started in July 2002 and a toxicologist joined the team. An inquiry was made to assess the level of knowledge of the general population on first aid in case of acute poisoning.

Two articles on mushroom poisoning were published at the local newspapers, and a brochure on first aid in case of acute poisoning was prepared and published.

Plans: to continue with distributing the brochure and assess the change in the level of knowledge after the educational campaign.



A training program in proper inhalation techniques for newly diagnosed asthma patients          


Mrs. Donka Georgieva


The project coordinator and two doctors identified all newly diagnosed patients with asthma who needed aerosol treatment. A brochure on proper inhalation techniques was prepared and distributed among the patients. Groups of patients and their relatives were formed to participate in the training sessions of the Asthma School.

Information on re-hospitalization rates of asthma patients before implementation of the project was collected.

The project team plans to continue with patient education and to assess the success of the project comparing rehospitalization rates before and after the project, and the patients’ skills to use inhalers.



A program to increase the knowledge on Lyme disease among the of the population of Gabrovo region


Mrs. Donka Stefanova


The project coordinator reviewed the available literature on the problem and prepared an educational brochure in collaboration with a doctor. A poster was prepared and placed in the outpatient clinic of the Regional Hospital. Tapes with a lecture on Lyme disease were produced and distributed to local radio stations of Gabrovo region.

The brochure will be distributed among the population in collaboration with general practitioners. An educational talk on the problem will be broadcasted on local television in early March 2003. Final assessment will be made using a questionnaire.

Difficulties were experienced due to the large scale of the project.



An educational program for the relatives of stroke patients


Mr. Emil Damianov


A brochure with instructions for rehabilitation and care after patient leave the hospital was prepared for the families of stroke patients. During the hospital stay a team of three rehabilitation therapists had individual talks and training sessions with relatives. For five months, the families of 50 stroke patients were included in the program. The brochure was given to relatives upon discharge of the patients. The team plans to continue the program at home with all patients living in Gabrovo. At the moment, four patients are under observation. The observation ended for eleven patients, who were visited in their homes twice by a team member for evaluation and providing assistance to the family.

Results: upon discharge, the average evaluation mark for those patients was “one” on the scale of standardized test for activities of daily living – the patients could manage only partially. As a result of the care provided by the family and the team at home, seven patients have improved their test results to “three”: they are independent in their daily activities. The other four patients have fully recovered the mobility and function of the lower limbs, and partially - the function of upper limbs.

The team members plan to continue visiting patients in their homes to monitor the recovery process and help the family. The final effect of the project will be assessed by a standardized test on functioning in activities of daily living in June 2003. 



An educational program to explain the necessity for bronchoscopy to patients with lung diseases         


Dr. Ivo Stanchev


The project started in August 2002. A team of a doctor (bronchoscopist) and 4 nurses was built. A video film on the procedures of bronchoscopy was purchased. The nurses were trained by the project coordinator how to prepare patients for a bronchoscopic examination, and a brochure for patients was prepared. The team also prepared and printed 200 informed consent-forms for patients referred for bronchoscopy. Individual talks with patients to motivate them to undergo the examination and to explain the procedures were carried out.

The team plans to print and distribute more brochures, and continue individual talks with patients. Final assessment will be made in September 2003.



Improvement on working conditions at the radiology unit of Gabrovo regional hospital


Mrs. Kremena Dimitrova


The project started in August 2003 and was completed in January 2003. The project team organized and did all the renovation work to prepare a room for the staff of the unit outside the area of radiation exposure.

The medical professionals were followed up for some somatic effects of radiation. The reduction of individual radiation dose due to improved working conditions was assessed by a check up of the individual dosimeters before and after the initiation of the project.

An inquiry among the staff revealed high level of staff satisfied with the project. The project has had a favourable effect to the health of radiologists and laboratory technicians at the unit due to reduced risk of professional radiation illness.



A program to raise the level of information on services offered to chronic and terminal patients by the hospice in Gabrovo


Mrs. Lyubka Dimitrova


A team was built to carry out the program, including social workers, four nurses, three doctors, and two volunteers, working together with the hospice staff. The first step was to assess the knowledge of the population of Gabrovo about hospice as an institution, and what care is offered by the hospice. Three hundred questionnaires were prepared and distributed to randomly selected patients in the waiting rooms of medical consulting centers in Gabrovo.

The information thus collected was used to assess the information needs and expectation of patients, and to plan appropriately the care offered at the hospice.

An information brochure was prepared describing the hospice activities, and different types of care that can be provided to chronic and terminal patients.



A program to prevent tuberculosis infections of the medical personal at the Gabrovo Regional Pulmonary Hospital


Mrs. Lyubka Dimitrova


In July 2002 a team of five nurses and two doctors was built. An inquiry was made among 90 medical professionals to assess their knowledge on protective measures while working with tuberculosis patients. Standard protocols on preventive measures and disinfection were developed with the assistance of an epidemiologist from Gabrovo Regional Hygiene and Epidemiology Station. Sessions were held with all the nurses, laboratory technicians and attendants where the standard protocols were presented.

The project team plans to have the standard protocols introduced into all the departments. Two more sessions for nurses, and one for the attendants will be held. The effect of the program will be assessed using a second end-of-training program questionnaire.



A program to decrease the time for medical documentation processing in maternity ward by introduction of computerized information system


Mrs. Maria Petrova


The project aims at setting up a reliable information system on the delivering women treated at the maternity ward, and at decreasing the time for documentation processing upon discharge. A laser printer was provided. A computer specialist helped the team to develop and introduce a system for computer processing of medical documentation of delivering women.

Results: the time of preparing the documentation necessary upon discharge from the maternity hospital has significantly decreased, as compared to the previous year.

The team had problems with the introduction of the system because of the outdated computer equipment available



A program to increase the number of blood donors in the region of Gabrovo


Mrs. Margarita Tsanova


The project started in December 2003. A broad information campaign was conducted among the general population of the region. The local mass media, the Red Cross and doctors-volunteers from the Regional Hospital were involved. Information leaflets were distributed; posters and other visual materials were displayed at public places.

As a result of the campaign, an increase in the numbers of blood donors was observed in comparison with the same period of the previous year. Rates were as follows: 25% increase in December, 10% - in January and 20% - in February.

The project is in progress and four more educational campaigns for recruitment of blood donors are forthcoming.



Reducing the level of stress of children admitted for hospital treatment at the ENT unit of Gabrovo Regional Hospital


Mrs. Maya Petkova 

A play corner was furnished at the admitting room of the ENT unit. A cabinet with toys and books for the children was made. Most of the toys and books were donated from the personnel of the unit. An artist painted the walls with funny pictures, and a carpenter made appropriate furniture.

A psychologist was included in the project to assess the level of stress reduction in the children who received treatment at the unit. Two standardized tests were developed for final evaluation of results. A questionnaire was used to assess the opinion of the parents and the medical staff.

The psychological tests of children revealed a significant reduction of stress and fear due to hospitalization. The parents evaluate the project positively, and found it very beneficial for removing the children’ fear from hospitalization.

The medical staff approved the play corner as a means of facilitating the clinical work with the children by decreasing their stress, reducing the pressure on professionals and improving the quality of examinations. 



Decreasing the risk for eye disorders due to oxygen therapy for the newborns at Gabrovo Regional Hospital


Mrs. Maya Dyukendjieva


The project coordinator found information about several firms producing equipment for oxygen therapy of newborns. Meetings were organized with the firms offering the most appropriate equipment and a selection was made. The firm with the best offer produced and granted to the hospital 3 oxygen tents that reduce the oxygen therapy risks for newborn babies.

The project results will be evaluated in 6 months on the basis of eye damage rates due to oxygen therapy before and after the implementation of the new equipment.



A program to prevent and control the nosocomial infections in ICU at the Regional Pulmonary Hospital of Gabrovo         


Mrs. Michaela Dimitrova       


The project was presented to and discussed with an epidemiologist from the Regional Hygiene and Epidemiology Station. A plan for the educational sessions with the staff of ICU was made, and an information brochure was prepared and distributed. In October, a three-day workshop on prevention of nosocomial infections for the staff of ICU was held.

The team plans to evaluate the results from the project activities by comparing incidence rates of nosocomial infections in the ICU during the year before the project with those after the implementation of the project.



A program to provide women with oncological diseases with information on radiotherapy health care services


Mrs. Milena Nedelcheva


Information on existing specialized services offering radiotherapy was collected, and a brochure for patients and their relatives was produced and distributed. Individual talks were given to each woman referred for radiotherapy.

Progress of the project was evaluated on the basis of results of ten women who received the information brochure. The project coordinator collected information from seven of the women at the time of initiation of radiotherapy. Treatment was started in less than 7 days after discharge from the hospital in Gabrovo.

The comparison made with a group of seven other women who did not have the information. Five of the latter group had not sought specialized radiological services within the 7-day period: they had spent the time trying to find information and seeking co-operation from their general practitioners, other medical professionals, from women treated in radiological units or their relatives. The other two women had gone to radiology clinics on time but were not admitted for treatment because of incomplete medical documentation.

The comparison showed that the information brochure was extremely useful for the patients; they saved time and received better treatment due to the timely initiation of specialized care.

Comments: As it is difficult to trace the women and obtain information on initiation of radiotherapy the number of women for the follow-up and evaluation of the project will be decreased.



Reducing the rate of low back pain of the nurses at neurology unit of Gabrovo regional hospital


Mrs. Milena Pencheva


The project started in September 2002. A physiotherapist prepared an appropriate set of physical exercises. The initial idea to involve only nurses from the neurology unit changed due to the great interest in the program of nurses from all hospital units.

The target group was selected from different units and included 35 nurses with low back pain. The group has training sessions three times a week. At the beginning of the program, a standard test was conducted on 15 nurses from the neurology unit to measure the mobility of spinal column. Mobility limitations in different segments of the spinal column were found out in all nurses tested.

A brochure with information on prevention of low back pain and pictures illustrating the exercises was prepared. The brochure was distributed among the medical staff of the hospital.

The effect of the project is to be evaluated at the end of April 2003 by a questionnaire, by assessment of absenteeism due to back problems and by the results from the standard mobility tests.



Hormone replacement therapy for women with early hysterectomy


Mrs. Natalia Kabakchieva


The project started in September 2002. An information brochure on different hormone-replacement medicines and the benefits of hormone-replacement therapy was prepared. The brochures were distributed among women in need of hormone-replacement therapy. A diary for 6-month follow-up observation of women with hysterectomy was produced. The follow-up program was started with 20 hysterectomized women aged 35-45. An inquiry was carried out among 15 of them, and more that half of them reported improved general and psychological health one month after initiation of replacement therapy. The rest of the group reported improvement after the second month of the therapy. The observation of patients is in progress and all new cases of early hysterectomy will be included.

The project will continue, and some general practitioners and gynaecologists in outpatient centers will be invited to participate. Information materials will be distributed among patients and posters about hormone-replacement therapy will be placed in the health centers in Gabrovo.



Prevention program to reduce early and late complications of diabetes mellitus Type I


Mrs. Neila Maknin


The program included 40 patients with diabetes mellitus Type I treated at the internal diseases and the nephrology units of Gabrovo regional hospital. Information materials on the disease and prevention of its complications were distributed. The team members gave personal talks to each diabetic patient.

The program was evaluated positively by 80% of the patients. Final assessment of the project will be made by comparing complication rates in diabetic patients from the target group to patients not included in the program.



An educational program to prevent smoking among students from 5th to 8th grade of "St. Cyril and St. Methodius" School in Gabrovo


Mrs. Nelvena Pencheva 

Literature on the problem was provided and teaching materials and a brochure were prepared in August 2002. The project was presented to the headmaster of the school and the teachers. A schedule for the lectures for the students was made, and at the end of September the first lecture was held.

Initial level of knowledge in the target group on the problem was assessed using a questionnaire, and the brochure was distributed among the students.

Lectures are to be held on a monthly basis. Final assessment of knowledge will be made in May 2003 (end of school year). End-of-project meeting with school authorities and community members to evaluate the results of the program will be also organized.



Health education program on secondary prevention of hypertension in patients aged 20-50 years


Mrs. Petia Ochkova


A team of two nurses and a cardiologist was built to work on the project. A diary for registration of blood pressure at home was produced and handed out to 30 patients enrolled in the program. They were provided with information materials on hypertension and its risk factors. Individual talks on measuring blood pressure, appropriate diet and prevention of complications were given to them. An information poster on hypertension and its complications was placed in the cardiology unit.

The effect of the project will be evaluated on the basis of rate of complications in the patients before and after the program



A program to increase the knowledge of chronic patients about their rights


Mrs. Petia Vitanova


Patients with severe chronic diseases have special rights to receive medical services according to the National Health Insurance regulations. The project aimed to increase patients’ knowledge about their rights. An information card was developed and distributed among chronic patients attending outpatient clinics, general practitioners, social services and various clubs of disabled people.

The effect of the project will be assessed in June 2003 by measuring the level of knowledge of patients about their rights and the number of cases of violation of these rights.



Reduction of stress and anxiety in patients undergoing total fibrocolonocscopy


Mrs. Radka Milcheva


A team of six nurses from internal disease units was built to work on the project.  A booklet on total fibrocolonoscopy was prepared and handed out to 100 patients with colon problems. Covering sheets to reduce the psychological inconvenience were made and used during the examination.

Trained nurses gave individual talks to each patient before the procedure.  The results of the questionnaire filled in by patients who had undergone total fibrocolcnoscopy showed reduction of stress and anxiety.



A program to establish hospital-based register of the patients with tuberculosis and to increase the population’s knowledge on specialized health services offered by Gabrovo regional pulmonary hospital


Mrs. Radostina Ignatova


The project coordinator prepared a form in which information collected from patients’ hospital documentation was filled. A computer program for registration and follow-up of tuberculosis patient was developed and introduced to facilitate the monitoring of disease process and treatment in each patient.

An inquiry was carried out to assess the patients’ knowledge of health services offered by the regional pulmonary hospital. Information was collected using a questionnaire to determine the population’s knowledge of health services offered by the regional pulmonary hospital.

The results were analyzed and used to improve hospital public relation policy and prepare a brochure on specialized medical services offered by the hospital.

Plans include printing and distributing brochures among the population. Assessment of the project will be made one year after the implementation of the project.



Organizing art activities for the children treated at the pediatric unit of Gabrovo regional hospital


Mrs. Rayna Gencheva


To improve on adaptation of children to hospital environment, art activities were organized on a regular basis. Children now spend more time painting, reading books, learning and writing poetry and other appropriate activities.

All these activities take place in the playroom, which was decorated as a result of a PSBH project, completed the year before.  New toys, teaching and working materials for creative activities were provided.

Paintings of the children were exhibited in the central hall of the unit.

A psychometric test and a questionnaire were prepared by a trained psychologist to assess the reduction of stress and children’ satisfaction with the planned activities.

Final assessment of the project is to be carried out end of April  2003.



An educational program for patients with high serum cholesterol


Mrs. Reneta Ilisanova


The project was started in September 2002. A team of two laboratory technicians and a doctor was built. The team produced an information brochure for the patients. It was handed out to the medical specialists to be distributed among high-risk groups.

About 50 patients were enrolled in the program. The level of blood lipids was tested in November and December 2002. The reduction of serum lipids and cholesterol in these patients will be assessed in August 2003.



An educational program on early detection and treatment of osteoporosis for one hundred women in active age


Mrs. Roumiana Ivanova


A team of a nurse, a doctor, a dietitian and a kinesitherapist was formed. The individual risk of women of the target group was assessed by a questionnaire and a high-risk group of 26 women was selected. In September 2002, an endocrinologist delivered a lecture on osteoporosis explaining the significance of prevention and early detection of osteoporosis. Ten women of the high-risk group underwent osteodensitometry.

The project team plans to have the rest of the high-risk group undergo osteodensitometric examination, prepare a brochure on prevention of osteoporosis and distribute it among the target group. An inquiry to assess the results of the project will be carried out in May 2003.



A program to reduce the rate of nosocomial infections in the neurology unit of Gabrovo Regional


Mrs. Stela Koleva


A team of two nurses and a neurologist was built, and assessment of available resources was made. Some sponsors and volunteers for the renovation works of quarantine room were involved in the project. Students from the local vocational schools helped to do repairs necessary. New regulations of disinfections and hygiene at the unit were developed and introduced.

The renovation of an isolated room is to be completed in April 2003, and the observation of nosocomial infection rate after the program will be carried out for 6 months.



Health education program for patients with cardio-vascular diseases to reduce the rate of rehospitalization


Mrs. Svetla Grancharova


So far, 143 patients have been included in the program, and all the 400 patients treated in the cardiology unit were interested in the program activities. Lectures were delivered on the risk factors and prevention of cardio-vascular diseases. An information board with educational materials was placed in the unit. The board is a valuable source of health education for patients ant their relatives. There is a significant increase in the knowledge of patients about cardio-vascular diseases.

Results so far: no changes in rehospitalization rates have occurred for the six months after the project was started. The team plans to continue with the project activities for another period of six months, and then assess the results.



An educational program on diet for cardio-vascular patients


Mrs. Julia Ivanova


The project was started in July 2002. A target group of 15 patients treated at the cardiology unit was formed. The project coordinator prepared a leaflet with diet recommendations, and the leaflets were given to the patients in the target group. Two sets of questions were developed to evaluate the level of knowledge on the appropriate diet for cardio-vascular patients before and after introduction of the educational program.

Final results of the program are to be assessed six months after January 2003.