2024-03-29T10:29:44Z
http://medlib.mef.hr/cgi/oai2
oai:medlib.mef.hr:47
2012-12-03T17:16:50Z
7374617475733D756E707562
7375626A656374733D57:573837
74797065733D746865736973
http://medlib.mef.hr/47/
Dijabetičar kao učestali posjetilac ordinacije obiteljske medicine
Vrca-Botica, Marija
W 87-96 Professional Practice
Frequent attenders (FAs) represent great workload for general practitioners. Chronic diseases are the leading cause for frequent consultations mentioned in literature. Former studies show that diabetic patients are among Fas at general practices in Croatia. Our study had three parts: A. Determination of standards for attendence at general practice offices and definition of standards for FAs in our settings. Attendence standards in general practice was calculated and followed at eight general practice offices on the sample of 4.312 patients and 58.088 visits. The patients who visited general practitioners above the average value for the upper quartilla of their age and sex groups were considered to be FAs. The study lasted from January 1, 1997 until December 31, 1999. B. Research on diabetics’ visits and factors influencing the number of their visits and the quality of health care of diabetics.Visits of 490 diabetics from 13 general practices were followed up, totally 1.170 absentees(??) and 16.670 visits. Diabetics whose number of visits was above the limited values for the upper quartilla for age and sex group were considered to be FAs. The rest of diabetic patients not categorized as FAs represented the control group in our study. The patients were not treated by any special program apart the usual national care for diabetes. The study lasted from January 1, 1997 until December 31, 1999. C. Qualitative study of subjective factors influencing the quality of care for diabetics - FAs was performed by the method of focus group. Results. There were 4.2 visits at general practice offices in 1997 and 4.7 in 1999 in total (general) population. In 1997 22% patients did 63% of frequent consultations while in 1999 it was 65%. The number of FAs increased in three years for 16.2%. According to the above mentioned methodology we determined that 285 (60%) diabetics out of 490 were FAs.In the course of three years the number of diabetics – FAs decreased for 6 or 2.8% while the number of FAs increased for 1.6%. Epidemiologica variables like age, sex, education and marital status did not influence the frequency of consultaions by diabetic patients. Insulin dependent diabetics, patients with longer history of diabetes, patients whose main disease was diabetes, patients who are using more dugs (frequency 1.6 against low frequency 1.5), patients on self control by strips or by apparatus are more frequently FAs. The patients having the higher index of severity of multimorbid diseases according to ICB-10/ICB-9/CI (by Charlson) (frequency 1.27 against low frequency 0.99) are more frequently FAs. Diabetics with the higher index of complications severity (IDC scale) (frequency 1.37 agaist non frequency 2.62) are less frequently FAs. Multivariate analysis shows that the patients controlled by internist, those treated by the family practitioner have less chance to be frequent attenders. Specific preventive procedures: determination of microalbuminuria, determination of lipids, check up of the posterior part of the retina by ophthalmologist, foot check up, are not optimal in our conditions and are not, according to our study factors for frequent attendence. HbA1c was determined in 24% of diabetics, more in FAs. Qualitative research showed that most diabetics – FAs were visiting their doctors for referrals and drug prescriptions. They did not think of their general practitioners as of professional persons for the treatment of diabetes. They thought that general practitioners did not offer enough instructions and recommendations for the treatment of diabetes. Diabetics thought their health was good. They mentioned their fear from blindness, gangrene and insulin.Their everyday life was restricted and they were socially isolated. Several joined factors - disease, practice and health care system are making diabetic patient to be FA.
2003
Thesis
NonPeerReviewed
application/pdf
en
http://medlib.mef.hr/47/1/vrca-botica_m.pdf
Vrca-Botica, Marija (2003) Dijabetičar kao učestali posjetilac ordinacije obiteljske medicine. PhD thesis, Sveučilište u Zagrebu.
oai:medlib.mef.hr:50
2011-09-23T16:12:07Z
oai:medlib.mef.hr:1651
2012-11-02T10:44:00Z
7374617475733D756E707562
7375626A656374733D57:5731
74797065733D746865736973
http://medlib.mef.hr/1651/
Mentorstvo i preporučiteljski odnos u akademskoj medicini
Sambunjak, Dario
W 1-28 Reference Works. General Works
Background-
Mentoring in academic medicine attracts an increasing attention of researchers and policy
makers. It is considered to be a catalyst of personal and professional growth and development,
as well as an important vehicle for the transfer of academic values and science-based practice
to the new generations of academic physicians. In the countries of scientific periphery,
mentors can help young researchers obtain a training in a recognized research center abroad
and thus contribute to the build-up of the scientific capacity of their home country.
However, the meaning and key features of mentoring are not always clear and the term is
used, sometimes inappropriately, to describe different forms of developmental relationships.
Also, the effects of mentoring need to be carefully evaluated and weighted against the costs,
as medical faculty are challenged by increasing clinical, administrative, research and
educational demands.
We conducted systematic reviews to explore and summarize the existing evidence about the
meaning, characteristics, prevalence and effects of mentoring in academic medicine.
Furthermore, we conducted a primary qualitative research to explore the use of senior
academicians’ informal networks to promote international mobility and scientific training of
junior medical researchers, as a part of mentoring and other developmental relationships.
Methods-
In the systematic review of quantitative research, we searched the Pubmed/MEDLINE,
Current Contents, Cochrane Database of Systematic Reviews, Database of Abstracts of
Reviews of Effects, Cochrane Central Register of Controlled Trials, PsycINFO, and Scopus
databases from the earliest available date to May 2006. We identified studies evaluating the
effect of mentoring on career choices and academic advancement among medical students and
physicians. Minimum inclusion criteria were the description of the study population and
availability of extractable data. No restrictions were placed on study methods or language.
Abstracted data were grouped thematically into evidence tables and interpreted.
In the systematic review of qualitative research, we searched Pubmed/MEDLINE, PsycINFO,
ERIC, Scopus and Current Contents databases from the earliest available date to December
2008 and included studies that used qualitative research methodology to explore the meaning
and characteristics of mentoring in the institutions of academic medicine. No restrictions were
178
placed on language of articles. The data were extracted, abstracted, summarized and
synthesized.
Primary qualitative research included 8 senior academicians who acted as the recommenders
and 8 physicians who used the senior academicians’ recommendations to get a research
training in a laboratory abroad. The sample was purposive, obtained by a snowball method,
and included participants from all four Croatian schools of medicine. Data were collected
through in-depth interviews, which were transcribed and analysed using the “Framework”
approach.
Results-
In the systematic review of quantitative research, the literature search identified 3640
citations. Review of abstracts led to retrieval of 142 full text articles for assessment; 42
articles, describing 39 studies, were selected for review. Most of these were conducted in
North America, and 34 (87%) were cross-sectional self-report surveys with small sample size
and response rates. One case-control study nested in a survey used a comparison group
without mentoring, and 1 cohort study had small sample size and large loss to follow-up. Less
than 50% of medical students and in some fields less than 20% of faculty members had a
mentor. Women perceived that they had more difficulty finding mentors than their male
colleagues. Mentorship was reported to have an important influence on personal development,
career guidance, career choice, and research productivity, including publication and grant
success.
In the systematic review of qualitative research, 8487 citations were identified, 114 full text
articles were assessed and 9 articles were selected for review. All studies were conducted in
North America and most focused on initiation and cultivation phases of the mentoring
relationship. Mentoring was described as a complex relationship based on mutual interests,
both professional and personal. Mentees should take an active role in the formation and
development of mentoring relationship. Good mentors should be sincere in their dealings with
mentees, able to listen actively and understand mentees' needs, and have a well-established
position within the academic community. Some of the mentoring functions aim at the
mentees’ academic growth and others at personal growth. Barriers to mentoring and
dysfunctional mentoring can be related to personal factors, relational difficulties and
structural/institutional barriers.
Qualitative research showed that the process of recommending junior physicians for research
training abroad can take four forms: 1) “forwarding information”, 2) “writing
179
recommendations” or “passive recommending”, 3) “active recommending”, and 4) “mentor
recommending”, with the increasing level of trust, commitment and the control over success,
and the decreasing number of possible recommendees from the first to the fourth form. Senior
academicians can best act as recommenders if they are sufficiently motivated, scientifically
active and internationally recognized, and have a personal experience of research training
abroad. Two distinct types of recommendees were identified – the ones with the previous
experience of research and collaboration with recommender, and the ones without such
experience. The former type is usually involved in mentor recommending, and the latter in
active or passive recommending. In the process of recommending, four important phases can
be identified: making the first contact and assessing the candidate, and the phases before,
during and after the research training abroad. Careful planning and preparation of both
leaving abroad and returing to home country are crucial for the success of the process of
recommending. The recommending can be beneficial for all the involved actors –
recommendees, recommenders and laboratories abroad, as well as for the scientific
community and broader society of the sending country. Brain drain is the major risk of the
process of recommending, but can be reduced by adequate planning and policies.
Conclusions-
Mentoring is a developmental relationship situated in a social context and shaped by the
institutional culture and climate. Successful mentoring requires commitment and interpersonal
skills of the mentor and mentee, but also a facilitating environment of the academic
medicine's institutions. Mentoring is perceived as an important part of academic medicine, but
the evidence to support this perception is not strong. Studies using more rigorous
methodology, addressing contextual issues and using control groups, prospective designs as
well as cross-disciplinary approaches, are needed to improve the quality of evidence for the
value of mentoring. The role of mentors in promoting mentees’ mobility and research training
abroad should be acknowledged. The institutions of academic medicine, especially those in
the countries of the scientific periphery, could facilitate and make use of this function by
introducing formal policies that encourage senior academicians to act as mentors and
recommenders, and junior researchers to take the opportunity of research training abroad.
2009-12-14
Thesis
NonPeerReviewed
application/pdf
en
http://medlib.mef.hr/1651/1/doktorat_Dario_final_za_tisak.pdf
Sambunjak, Dario (2009) Mentorstvo i preporučiteljski odnos u akademskoj medicini. PhD thesis, Sveučilište u Zagrebu.
oai:medlib.mef.hr:1692
2020-04-28T11:56:42Z
7374617475733D756E707562
7375626A656374733D57:57363031:573630315F31
74797065733D746865736973
http://medlib.mef.hr/1692/
Osobitosti sjećanja oca i majke na traumatski događaj nestanka i posmrtne identifikacije sina deset godina poslije nestanka : kvalitativna analiza
Jurčević, Slavica
W 601-750 Reference and General Works
Aim: To assess memory characteristics of parents in regards to the trauma caused by the
disappearance and postmortem identification of their sons, ten years after the sons were
reported missing. -----
Study design: Qualitative analysis of the content of memory. -----
Sample size: Testimonies were taken from 13 mothers and 7 fathers, out of which 6 mothers
and 3 fathers have identified their sons postmortem. Mothers' median age was 65 (53-77), and
fathers' 67 (60-75). -----
Place of study: The interviews were held in 4 villages situated NE and SW from Osijek:
Laslovo, Ernestinovo, Bilje i Darda; out of which, in the beginning of 1991, 21 persons have
been reported missing. Sons' median age, at the time of their disappearance was 31 (18-41). In
the ten years after the disappearance, 6 out of 21 were identified postmortem, while the
remaining 15 are still listed as missing. -----
Methods: Interviews were recorded and translated verbatim adding the interviewers comments
and descriptions of the observed behavior. Interviewees were asked to recall their most
traumatic event, which was then analyzed according to the protocol for the traumatic memory.
The interviews were ended when the topic was thoroughly exhausted, or when the
interviewees' thoughts started to repeat. Theoretical starting point was Bowlby's theory of
mourning. Analyzing the contents of the memories, descriptions that were similar or the same
were grouped into topics. These topics represent units of memory's content, and initially 173
different ones were coded. Evaluation Forms for the testimonies consisted of those 173 topics,
followed by an evaluation scale. The pilot testing consisted of 62 topics, with a confidence
interval of 0,05 and sampling error of 0,03. For two evaluators Krippendorff's alpha
coefficient was insufficient and they were excluded from the study, while the remaining 3
evaluators continued their analysis on all 173 topics. The process of stratification of the coded
topics consisted of 3 phases: For Phase 1 Krippendorff's alpha coefficient was set to 0,30
which yielded 80 out of 173 topics. In Phase 2 Krippendorff's alpha coefficient was set to
0,40 yielding 53 topics. Finally in Phase 3 Krippendorff's alpha coefficient was set to 0,50
yielding 30 topics. These 30 topics were present in the testimonies of 11 mothers and 6
fathers with Krippendorff's alpha coefficient 0,60 – 0,82. -----
Final results' measures: From the parental memories of the trauma caused by the
disappearance of their sons it was possible to construct 10 sensorial and emotional episodes:
1. Fear that something so foreign and alien, as DNA-analysis is, could determine the faith of
the missing son; 2. The missing person is a – 'scapegoat'; 3. Picking of a 'memorial candle' for
128
the missing; 4. Belief in the supernatural – 'perhaps a miracle will still happen'; 5. Tiredness
brought on by the search for the missing - 'burying the dead so that the living could live'; 6.
The content of dreams directs daily behavior – 'dream as an active reality check'; 7. Preserved
objects belonging to the missing son (clothes, etc.) are proof that the he is alive; 8. Confession
– 'the sacrament of repent and acceptance'; 9. Hope – 'subconscious expression of belief in
ones surroundings'; 10. Flash-back episodes – 'sensory delusions and body manifestations,
decompensation'. -----
Final results: A post-traumatic dissociative reaction is highest during the recollection of an
anticipated or actual postmortem identification of the missing son by DNA-analysis in cases
when visual identification is not possible (fragmented body parts: pieces of bone, dental parts,
etc.) The ways fathers describe events relating to the missing son are statistically very
different from the way mothers do so. Mothers' narrative testimony depicts them trying to
conclude the story of their son's disappearance based upon very scarce information they
posses. Another trait of the mothers' narratives about their missing sons that have been
identified postmortem, is the lack of mentioning the way the sons died. The fathers, on the
other hand, depict the traumatic event by switching the observer and the acting roles for
themselves, with a stereotypical narration in which societies attitudes towards the war, toward
the victim and toward other individuals is expressed. Two attitudes dominate the fathers'
testimonies: 'the missing son is dead' and 'the wish to find and bury the missing son'. -----
Conclusions: Testimonies regarding the missing sons can be viewed as consisting of 10
seperate stories, each accompanied by its emotional and sensorial image. Emotional reaction
brought on by the disappearance and the postmortem identification of their sons by DNAanalysis
seems to be captured within a symbolic context (verbal system) and linked to these
specific images and emotional episodes. This enables the mourning parents to tell their story
in an episodic form. Flashbulb memories, therefore, become the center points of a
disappearance narrative, and are then easily linked to other episodes wither thematically
similar or emotionally similar. This ontological narrative about the missing son who was
identified postmortem, enables not only a social approach, what has so far been the traditional
approach, but also an individual approach to a narration as a limited way of self presentation.
2011-03-07
Thesis
NonPeerReviewed
application/pdf
en
http://medlib.mef.hr/1692/1/Doktorska_disertacija_Slavica_Jurcevic.PDF
Jurčević, Slavica (2011) Osobitosti sjećanja oca i majke na traumatski događaj nestanka i posmrtne identifikacije sina deset godina poslije nestanka : kvalitativna analiza. PhD thesis, Sveučilište u u Zagrebu.
oai:medlib.mef.hr:2119
2014-05-28T08:34:32Z
7374617475733D756E707562
7375626A656374733D57:5731
74797065733D746865736973
http://medlib.mef.hr/2119/
Utjecaj organizirane edukacije iz područja medicinske nastave na kvalitetu rada nastavnika medicinskog fakulteta
Pjevač, Neda
W 1-28 Reference Works. General Works
Medical education is part of a school of medicine complex system along with scientific
research and work in health care system. Educational activity is responsible task,
without it schools of medicine couldn’t achieve expected role in economic,
technological and cultural development of society and state. Training of teachers during
study of medicine is carried out in various ways. It is based on two identified problems
(how to effectively improve medical teachers in field of knowledge and skills of
medical education and whether a teacher trained in art of medical education work better
in same conditions?).
This study was conducted based on two hypotheses: (1) organized training program in
skills of medical education meet up expectations of students and (2) organized training
program in skills of medical education leads to better quality of teaching.
The objectives of the study were to (1) investigate and analyze factors that affect the
quality of organized continuous training program in medical education (2) to explore
and analyze the impact of completion of organized training program to future work of
teachers in study of medicine. Specific study objectives were: (1) to investigate factors
that affect coming of teacher on organized training program, (2) to analyze
characteristics of participants of organized training program, (3) to explore factors that
influence satisfaction or dissatisfaction of participants (objectives, organization , mode
of work, etc.), (4) to determine opinions and suggestions of participants regarding need
of improving existing programs, and (5) to analyze participants evaluation scores of
training teachers and to compare scores of participants who successfully completed the
program with a control group of participants who didn’t complete the program.
The survey was conducted among participants of postgraduate first category course
entitled "The art of medical education" organized by Croatian Association for Medical
Education. Respondents (total 224) were teachers University of Zagreb School of
medicine who attended the course from year 2002 to 2010. In accordance with
objectives of the study, several methods were applied: (a) analysis of participants
characteristics according to data in the archive of course participants, (b) analysis of
participants introductory essays where the reasons and expectations for participation
were described, (c) analysis of data collected by questionnaire sent to participants (
58%) to determine their opinions about the completed course and recommendations
how to organize training of teachers in medical education, (d) analysis of the
effectiveness of the course on their work by comparing students' evaluation before and
after the course, and (e) work in focus groups for a more detailed explanation of
motivation, evaluation of quality of the course and suggestions for criteria in selection
and promotion in teaching and scientific professions.
The study results showed that for all respondents the most important motive for coming
was to learn something new, and renovation of existing knowledge and need to
complete the course as a requirement for future promotion. Less important motives were
associated with promotion in assistant professor, referral by Chair and least desire for
renewal of existing knowledge.
In course review, participants emphasised, as most valuable subjects, active methods of
work and organization of the course, followed by comprehensiveness and
accomplishment of their expectations. Very well evaluated was interest, pleasure with
suggestion of shortening of course on less than a week. The whole course is very highly
evaluated - very good grade scored by 48.4% and excellent by 22% of respondents.
In personal evaluation of effectiveness of the course on their teaching work the
participants stated that after the course the biggest change occurred in development of
positive attitudes to teaching, followed by small design innovations in methodological
units and relation with students. The least change occurred in involvement of Chair
work, introduction of elective courses and even less in active work in School of
medicine committees and interest for research in medical education. Most of
participants think that all teachers should attend such a course, regardless of age,
academic and scientific professions (69% of respondents) while 31% of participants
think that attendees should be only younger teachers.
Comparison of students average evaluation score of teachers, who teach same subject,
showed higher score (23/35) of teachers who passed the course, same score (4) and just
one lower score.
This study implies the effectiveness of organized training program for teachers on
quality of their work in education and need to adjust the course according to suggestions
of participants and constant monitoring of course quality.
2012-07-20
Thesis
NonPeerReviewed
application/pdf
en
http://medlib.mef.hr/2119/1/Neda_Pjeva%C4%8D_disertacija_2012.pdf
Pjevač, Neda (2012) Utjecaj organizirane edukacije iz područja medicinske nastave na kvalitetu rada nastavnika medicinskog fakulteta. PhD thesis, Sveučilište u Zagrebu.
oai:medlib.mef.hr:2648
2017-02-01T12:46:41Z
7374617475733D756E707562
7375626A656374733D57:57363031:57373735
74797065733D746865736973
http://medlib.mef.hr/2648/
Karboksihemoglobin kao pokazatelj ulazne strijelne rane nastale pucanjem iz blizine [Evaluation of carboxyhemoglobin as an indicator of close range entrance wound]
Baković, Marija
W 775-867 Medicolegal Examination
Determination of the direction and distance of shooting is one of the essential tasks of forensic autopsy of individuals with lethal firearm injuries. Establishing the entrance wound is the first step in the right direction. Generally, the assessment is based on the wound morphology, which is not always typical. This imposes the need for additional, objective methods for the identification of entry wound.
In close range shots, propellant gases are blown into the tissues around the bullet tract which causes formation of carboxyhemoglobin (CO-Hb).
We aimed to investigate the levels of CO-Hb in blood from close range wounds and determine the relationship of CO-Hb concentrations in entrance and in associated exit wound.
Blood samples from the entrance and exit wound and a control sample of femoral blood were collected from the fatally injured gunshot victims. Blood samples were collected only in cases of prompt death and in absence of developed postmortem changes. Blood samples were analyzed by quantitative spectrophotometry according to Heilmeyer. Additional information regarding the weapon and ammunition type and the postmortem interval were collected.
CO-Hb was detected in 89% of cases of close range shoots, either in entrance or associated exit wound. CO-Hb concentrations were significantly higher in entrance (11.68±10.06) than exit (3.38±4.63) wounds. In cases of shooting in oral cavity frequency of detection of CO-Hb as well as CO-Hb concentrations were lower. Excluding these cases, CO-Hb concentrations were higher in 86% of entrance wounds than in associated exit wounds. Highest concentrations of CO-Hb were detected in cases where 7.62 – 7.65 caliber bullet was used. The length of postmortem interval did not affect the CO-Hb concentrations. The gradient of CO-Hb was not detected in
11% of cases while in 5% of cases the concentration of CO-Hb was higher in exit wound than in associated entry wound.
These results support the conclusion that CO-Hb levels are significantly higher in blood samples collected from close range entry gunshot wounds than associated exit wounds. The observed difference of CO-Hb levels allows for determination of entrance versus exit wound. Presence of CO-Hb is very good indicator of close range shot. The postmortem stability of CO-Hb was verified.
2013-10-04
Thesis
NonPeerReviewed
application/pdf
en
http://medlib.mef.hr/2648/1/MARIJA%20BAKOVIC.pdf
Baković, Marija (2013) Karboksihemoglobin kao pokazatelj ulazne strijelne rane nastale pucanjem iz blizine [Evaluation of carboxyhemoglobin as an indicator of close range entrance wound]. PhD thesis, Sveučilište u Zagrebu.