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Science

With the embracement of the JCI accreditation and implementation of Quality Improvement and Patient Safety (QPS) and Human Subjects Research Programs (HRP) standards, we have embarked on a unique path to promote and support Scientific Inquiry, Clinical Research and Continuous Education in our hospital

In particular, QPS.3 “The quality and patient safety program uses current scientific and other information to support patient care, health professional education, clinical research, and management.” and HRP.2 “Medical research conducted at the hospital represents varied medical areas and/or specialities within the organization and includes basic, clinical, and health services research. Such research may include clinical trials, therapeutic interventions, the development of new medical technologies, and outcomes research, among others.”

We are a private clinic with no organisational nor administrative ties with Academia; however, we do value a growth mindset and aim to improve our academic engagement and performance.

With the appointment of Dr Rodney Rosalia as the Chief Scientific Officer since September 2017, we aim to propel our scientific ambitions, partner with foreign scientists and collaborate with international research institutes.

Our goal is to establish the Zan Mitrev Clinic as a loco-regional research and training institute.

To this end, we have established a research ethics committee, headed by Mrs. Frosina Ristovska and an Institutional Review Board (IRB) led by Dr Rodney Rosalia and Dr Zan Mitrev. These two independent committies review, approve and provide oversight on ongoing medical research on human subjects in compliance with international regulations, and Good-Clinical-Practice and Ethical guidelines.

In addition, a scientific research club consisting of research enthusiast gather to discuss notable scientific discoveries and achievements that could directly impact our clinical activities – These activities are coordinated by Mrs Viktorija Dojcinovska – Mileva  and Dr Rodney Rosalia

 

Approach

To foster Clinical Research at ZMC, our hospital staff are encouraged to engage with scientific activities.

To facilitate this process, we provide continuous education to our employees and stimulate participation at national and international conferences, workshops and training courses.

Moreover, we have successfully set up several investigator-initiated observational studies and currently participate in one large multi-centre trial.

 

Ongoing International Collaborative Research Activities

  • ESBL-predict, A prospective, multi-centre, observational cohort study in collaboration with Drs. J.W.T. Deelen and Prof. from the Julius centre for health sciences and primary care and dr. M.J.M. Bonten, Department of Medical Microbiology University Medical Center Utrecht.

The aim of the study is the “Validation of a clinical prediction rule for third-generation cephalosporin resistant bacteremias.”

This study is conducted within our clinic by MSc of Pharmacy, Mrs Sanja Stojanovska under the supervision of Dr Rodney Rosalia

  • DecubICUs is a Multicentre International One-Day Prevalence Study on Pressure Injuries in Intensive Care Units.

https://www.esicm.org/research/trials/trials-group-2/decubicus/

The objective of this study is to provide an up-to-date, global picture of the extent and patterns of pressure injuries in ICUs.

The study has so far included 11.825 patients. Thereby, it is among the most large-scaled projects ever conducted in the field of intensive care as well as of pressure injuries.

DecubICUs is coordinated within our clinic by the ICU Head Nurse, Mrs Zaneta Bogoevska-Miteva and Dr Rodney Rosalia

  • MET-REPAIR, “METREevaluation for Perioperative cArdIacRisk” a European, Prospective, observational, multi-centre cohort study”.

Chief Investigator Dr Giovanna LURATI BUSE (University Hospital Düsseldorf, Düsseldorf, Germany)

http://www.esahq.org/met-repair

A core question in the preoperative cardiac risk assessment recommendations is the estimation of cardiovascular functional capacity in metabolic equivalents (METs)

The MET-REPAIR study aims to address the question: “Are METs estimated by questionnaire associated with perioperative major adverse cardiovascular events and cardiovascular mortality in patients undergoing elevated-risk, noncardiac surgery?

The primary endpoint will consist of in-hospital major adverse cardiovascular events including cardiovascular mortality, nonfatal cardiac arrest, acute myocardial infarction, stroke, congestive heart failure requiring transfer to a higher unit of care or prolonged stay on ICU.

MET-REPAIR is organised through the European Society for Anesthesiology and within our clinic is coordinated by Dr Petar Ugurov

  • NCT03006770, a randomised, placebo-controlled, parallel group, multicenter, Phase III study.

This study is conducted by Pluristem Therapeutics, http://www.pluristem.com/, and aims to evaluate the Efficacy, Tolerability and Safety of Intramuscular Injections of PLX PAD for the Treatment of Subjects With Critical Limb Ischemia (CLI) With Minor Tissue Loss Who Are Unsuitable for Revascularization.”

The Principal Investigator for this study is Dr Nikola Hristov who is supported by Dr Milka Klinceva, Dr Enver Idoski and Dr. Rodney Rosalia, Emilija Kostoska MSc of Pharmacy and the research nurses Mrs Elena Sultanceva and Mrs Natka Kusevska

 

Ongoing Investigator-Initiated Clinical Research Activities

Several ZMC medical experts are currently involved in ongoing research studies with the aim to improve our clinical practice and engage in evidence-based medicine.

These studies are supervised by Dr Rodney Rosalia, on behalf the ZMC IRB and the Local Ethics committee.

Some of these studies, case reports, and case series have received international appraisal in the form of guest lectures, consultancy invites, acceptance and publication of our work in the form of conference abstracts and manuscripts.

An overview

  • Dr Petar Ugurov, ESCVS`18, Strasbourg

CVVHDF before TEVAR in a Polytrauma Patient with Stanford B Dissection, https://www.escvs2018.com/abstract-book/      

  • Dr Dijana Popevski, ESCVS`18, Strasbourg

Continuous renal replacement therapy with cytokine-adsorbing hemofilters for the treatment of Myocarditis, https://www.escvs2018.com/abstract-book/

  • Dr Nikola Hristov, ESCVS`18, Strasbourg

Long-term results using negative pressure wound therapy for treatment of sternal infections, https://www.escvs2018.com/abstract-book/

  • Dr Planinka Zafirovska, Euro HF`18, Vienna

Left Ventricular Global Longitudinal Strain as a predictor of Left Ventricular Reverse Remodelling after Surgical Aortic Valve Replacement, https://onlinelibrary.wiley.com/doi/abs/10.1002/ejhf.1197 Ongoing study, full manuscript in preparation

  • Dr Dijana Popevski, Euroanesthesia`18, Copenhagen

Continuous renal replacement therapy with cytokine-adsorbing hemofilters for the treatment of Myocarditis https://www.esahq.org/resources/resources/abstract-books Ongoing study, data collection not completed, if interested to participate in this study, please contact Dr Rodney Rosalia 

  • Dr Dijana Popevski Poster, Euroanesthesia`18, Copenhagen

The use of Continuous Venovenous Hemodiafiltration with Cytokine-Adsorbing Hemofilters and Medical Ozone as Adjuvant Therapy for Descending Necrotising Mediastinitis https://www.esahq.org/resources/resources/abstract-books

  • Dr Milka Klinceva, ECS`18, Munich

CYP2C19-dependent Clopidogrel resistance is a possible cause for coronary stent and peripheral bypass occlusions, https://academic.oup.com/eurheartj/article-abstract/39/suppl_1/ehy564.P961/5081153 Ongoing study, full manuscript in preparation, if interested to participate in this study, please contact Dr Rodney Rosalia

  • Zaneta Miteva, IBU-ICSSH18, Skopje

From Novice to Expert – Pioneering Educational Concepts for Nurses: A Single Center experience, https://www.ibu.edu.mk/event/international-conference-on-social-sciences-and-humanities18-icssh2018/ Ongoing study, data collection not completed

  • Frosina Ristovska, IBU-ICSSH18, Skopje

Personality Traits and Coronary Disease – Agreeableness and Openness to Experience fail to Predict Coronary Disease in Male Macedonian Hypertensive Patients, https://www.ibu.edu.mk/event/international-conference-on-social-sciences-and-humanities18-icssh2018/

  • Dr Igor Zdravkovski & Dr Rodney Rosalia, Highlights in Acute Coronary Syndrome 2018, Skopje

Severe kidney injury and old age are risk factors for prolonged hospitalisation after surgical treatment of Coronary Artery Diseasehttp://mscardiology.org.mk/simpozium2018/index.php Ongoing study, data collection not completed, if interested to participate in this study, please contact Dr Rodney Rosalia

  •   Dr Rodney Rosalia

The AKR1D1*36 (rs1872930) allelic variant is independently associated with Clopidogrel treatment outcome in Acute Coronary Syndrome patients

A collaboration with Aleksandra Kapedanovska-Nesterovska, Aleksandra Kapedanovska-Nestorovska, PharmD PhD from the faculty of pharmacy, Faculty of Pharmacy, University Ss Cyril and Methodius

Manuscript Submitted for peer-review

  • Dr Zan Mitrev, Dr Dijana Popevski and Dr Rodney Rosalia

CRRT with Cytokine Adsorbing Hemofilters for the treatment of Cardiac Surgery associated systemic inflammation and Kidney Injury

Ongoing study, full manuscript in preparation, if interested to participate in this study, please contact Dr Rodney Rosalia 

  • Dr Zan Mitrev, Dr Tanja Anguseva and Dr Rodney Rosalia

Aortic Leaflet Replacement for Small Root Aortic Stenosis Patients Ongoing study, full manuscript in preparation, if interested to participate in this study, please contact Dr Zan Mitrev

 

Published Researched (2018)

Mitev K, Neziri D, Stoicovski E, Mitrev Z.

J Med Case Rep. 2018 May 29;12(1):150. doi: 10.1186/s13256-018-1683-2.

 

Stajkovska A, Mehandziska S, Stavrevska M, Jakovleva K, Nikchevska N, Mitrev Z, Kungulovski I, Zafiroski G, Tasic V, Kungulovski G.

Front Genet. 2018 Apr 5;9:113. doi: 10.3389/fgene.2018.00113. eCollection 2018.

 

Ongoing Continuous Education Programs

Research Nurse, Mrs Elena Sultanceva

Research Nurse, Mrs Katerina Janev

Dr Petar Ugorov

Dr Ilija Neskovski

Dr Dijana Popevski

Dr Tanja Gramosli

Dr Dragica Vuckova

Dr Emil Stoicovski

Dr Dashurie Neziri, MSc 

Research Nurse, Mrs Zaneta Bogoevska-Miteva

Goran Kungolovski, PhD

Slavica Pecioska, MSc

Dr Marko Gjorgon

Rodney Rosalia, PhD

Furthermore, Mrs. Emilija Kostoska, is certified in Good-Manufacturing-Practice, https://www.who.int/biologicals/vaccines/good_manufacturing_practice/en/

 

  • Acute Care Expert symposium and Continuous Education

The ZMC ICU MD staff are heavily involved within in the European framework of Acute Care Experts. Our staff is undergoing advanced training for the use and application of Blood purification based Renal Support approaches for the treatment of the critically ill, https://portal.baxter.semcon.com/content/education-evaluation-4555.html

Also, we have organised an international symposium that fostered debate and knowledge exchange between our intensivists/anaesthesiologists and invited lecturers, trainee experts and loco-regional experts.