Computer laboratory in medical education for medical students

Five generations of the second year students at the Zagreb University School of Medicine were interviewed through an anonymous questionnaire on their use of personal computers, Internet, computer laboratories and computer-assisted education in general. Results show advance in using the information and communication technology by medical students during the period from 1998/99 to 2002/03. However, their positive opinion about computer laboratory depends on installed capacities: the better technology in the computer laboratory – the more positive opinion of it

Comparison and Analysis of Provisions in International Standards ISO 9004:2009 and ISO 9004:2000

U radu se uspoređuju zahtjevi međunarodnih norma za sustave upravljanja kvalitetom ISO 9004:2000 i ISO 2004:2009. Sadržaj svake norme raščlanjuje se na glavne točke (poglavlja) i podtočke, te se uspoređuje njihov sadržaj. Dolazi se do spoznaja što je izmijenjeno u novom izdanju iz 2009. godine, objašnjava se zašto su uvedeni ti noviteti i koja su njihova obilježja. Ujedno se komentiraju one točke iz prethodnog izdanja koje su izostavljene ili uključene u druga poglavlja novog izdanja. Kratko se obrazlažu one točke zajedničke za obje norme. Daje se naglasak na dvije bitne novine u normi ISO 2004:2009. To su održiva uspješnost neke organizacije i drugačiji pristup samoocjenjivanju organizacije poradi postizanja i održavanja održive uspješnosti.The paper makes a comparison between the provisions stipulated by international standards for quality management systems ISO 9004:2000 and ISO 9004:2009. The content of each standard is divided into paragraphs and sub-items and respective contents are compared. Conclusions are made on changes effected in the new edition from 2009, explanations are offered on the reasons for these changes and their characteristics. The paper also elaborates on the items from previous editions that have been omitted or integrated into other paragraphs in the new edition. A short explanation of the common items in both editions is given. Special emphasis is given to two major novelties in the ISO 9004:2009 standard: sustained success of an organisation and different approach to self-assessment of an organisation to achieve and maintain sustained success

ZNAČENJE LUKE MOLUNAT S POMORSKOG I GOSPODARSKOG STAJALIŠTA (prošlost, sadašnjost i budućnost)

Autor opisuje luku Molunat i njezino značenje s pomorskog i gospodarskog stajališta u prošlosti, sadašnjosti i budućnosti. Tako govori o ranom naselju i njegovom povijesnom i strateškom značenju u srednjem vijeku, kad je došao u sastav Dubrovačke Republike. Daje kratke podatke o razvoju mjesta (naseljavanju i povezivanju s magistralnim putovima u zaleđu pred 100 godina). Osobito se osvrće na razvoj mjesta u posljednja dva desetljeća. Vidi razvoj Molunta u perspektivi kao pravi lučki i trgovački mali grad sa svom potrebitom infrastrukturom

Stavovi i trend promjena stavova studenata medicine prema uporabi informacijske i komunikacijske tehnologije u učenju medicinskih sadržaja

Over the past five successive academic years, we have surveyed the changes in the use of computers for medical studies with 2nd-year students. The survey covered the following academic years: 1998/99, 1999/2000, 2000/2001, 2001/2002, and 2002/2003. A random sample yielded 537 student completed questionnaires. The average age of respondents was 20 years. We found out that 84% of students had used computers even before enrolling the university. The responses obtained over the past five generations indicated clearly an increase in the number of students who had used computers before enrolling the university. Responses on the use of computers at home and at the university showed that younger generations expectedly used computers more often, and the number of students who either did not want or did not know how to use computers was low and showed a decreasing trend with the younger generation. In the last study generation, the number of students who did not have access to computers was reduced to zero after a clear decreasing trend. This study shows that over the study period a high percentage of students used the Internet over week days, and the younger generations used the Internet more frequently. Also, we observed a great drop in the number of students who never used the Internet, from 36% in the first study year to only 24% in the last study year. Analyzing e-mail use over the study period, we observed a significant decrease in the number of students who did not have a single e-mail address thus not using this service as an important form of modern communication in their work and learning process. We also observed an increase in the number of students with several e-mail addresses. Most respondents used the computer for their studies. All student generations expressed a combined communication between the teacher and the student as the most acceptable, almost in identical percentages. Over 90% of respondents agreed that the best understanding of the subject matter during the learning process would be achieved if they used the combined learning method. Over the generations, these results did not show any significant changes; the younger generations even slightly preferred the classic teaching methods. Over the study period, differences were observed in the opinion and attitudes of students on the use of computers for studying and work. The results showed that 86.8% of female students and only 13.2% of male students did not use computers because they did not have access to computers. Also, 82% of female students and only 18.2% of male students did not use computers because they did not know how to. A higher number of female than male students replied that they rarely accessed the Internet – from several times a month to never. Over the study period, 72% of female students did not have an e-mail address as compared to 28% of male students; 65% fof emale students did not use computers for studies as compared to 35% of male students; 65% of male students preferred e-mail communication with their teachers, as compared to only 40% of female students. Correspondence analysis of answers to open-ended questions (free-text answers to questions 8, 9, 10, and 12) and academic study years showed differences in the attitudes in generations 1998/1999 and 1999/2000 on one side, and 2001/2002 and 2002/2003 on the other side

Gunshot Injury of the Foot: Treatment and Procedures – A Role of Negative Pressure Wound Therapy

Civilian gunshot injuries of the foot are not so common in Croatia. They are related with accidents in hunting or weapon cleaning. Gunshot injuries represent a special challenge for surgeon because of specific anatomical relations and biomechanical function of the foot. We have decided to present a patient with a complex foot injury caused by hunting firearm in self-inflicted accident. A 45-year-old male presented with 12-gauge shotgun wound to his left foot. We found a complicated fracture with bone defect of 3rd, 4th and 5th metatarsals and wide soft tissue injury with skin and subcutaneous defect of the dorsal and lateral side of the foot. The wound was contaminated with numerous metal fragments, particles of rocks and ground. Surgical treatment was performed three hours after trauma and included extensive debridement of damaged soft tissue, removing of the non-viable bone and metal fragments, rocks and other foreign bodies. Negative Pressure Wound Therapy (NPWT) was applicated in the operating table. The starting therapy was continuously –125 mm Hg of vacuum. We continued with intermittent therapy of –100 mm Hg and change NPWT dressing every fourth day. After four weeks of NPWT the defect was filled with granulation tissue and split thickness skin graft was applied. Skin graft was additionally fixed with NPWT using continuous therapy at –100 mm Hg for a period of four days. Forthy days after injury there was a complete healing of all soft tissue. Control X-ray showed good bone healing process

Ankle syndesmosis: anatomy, mechanisms of injuries, diagnosis and treatment

Distalni tibiofibularni zglob odgovoran je za širinu i stabilnost takozvane zglobne viljuške gležnja koju sačinjavaju distalna tibija i distalna fibula. Prema nekim autorima tijekom uganuća gležnja u 95 % slučajeva dolazi i do ozljede ligamenta distalnog tibiofibularnog zgloba. Upravo je prepoznavanje ovih ozljeda od velike važnosti, jer se pacijenti s tim ozljedama liječe dvostruko dulje od pacijenata s ozljedama ligamentarnih struktura lateralne strane gležnja, a do povratka sportskim aktivnostima protekne i do 6 mjeseci. Standardni klinički testovi i klasične rendgenske snimke nisu često dostatni za postavljanje dijagnoze, pa je pri sumnji na ozljede sindezmoze potrebno učiniti i magnetsku rezonanciju. Način liječenja akutnih izoliranih ozljeda sindezmoze ovisi o stupnju nestabilnosti gležnja. Danas još uvijek postoje nedoumice i nesuglasja u postavljanju dijagnoze i liječenja takvih ozljeda. U ovom radu pokušali smo na sistematičan način prikazati anatomske karakteristike distalnog tibiofibularnog zgloba, ali i najnovije stavove u dijagnostici i liječenju ozljede sindezmoze.Distal tibiofibular joint is responsible for the distal crucial anatomic structure responsible for the ankle joint stability. According to some authors syndesmosis injury occurs in 95% of the lateral ankle sprain during sport activity. Syndesmotic injuries often require twice as long to return to sport as compared to isolated lateral ligament sprains and can lead to prolonged pain and disability. Clinical tests and plain radiography have limited diagnostic capacity and often MRI imaging is necessary. The treatment of the acute isolated syndesmotic injury depends on the ankle stability. Today still, there is some doubt and disagreement regarding diagnostic criteria, classification, and treatment of syndesmotic injury

USE OF NEGATIVE PRESSURE THERAPY IN THE TREATMENT OF PRIMARY INFECTED TRAUMATIC WOUNDS OF THE FOOT CAUSED BY HIGH ENERGY IMPACT

Ozljede stopala uzrokovane vatrenim oružjem i radnim strojevima za pranje pod visokim tlakom nisu česte, ali zbog visoke energije ozlijeđivanja mogu biti veoma destruktivne te kontaminirane mikroorganizmima. Zbog anatomskih specifičnosti stopala, često su ozlijeđene specifične strukture kao što su krvne žile, živci i tetivno– ligamentni aparat. ove su ozljede često praćene defektom mekog tkiva. Funkcionalni i estetski oporavak stopala je izazov za kirurga. Terapija negativnim tlakom (TNT) svojim direktnim i indirektnim djelovanjem pomaže u cijeljenju rana i daje dobru pripremu za definitivno kirurško zbrinjavanje rane.Foot injuries caused by firearms and high pressure washing machines are not common, but due to high energy can be very destructive and contaminated with microorganisms. Due to the anatomical specificity of the foot, injures of the specific structure such as blood vessels, nerves and tendon-ligament apparatus are frequent. Soft tissue defect is often present. Functional and aesthetic recovery of the foot is a challenge for the surgeon. Direct and indirect effect of the negative pressure therapy helps in wound healing and provides good preparation for definitive surgical management of wounds

Regression of Moral Reasoning during Medical Education: Combined Design Study to Evaluate the Effect of Clinical Study Years

BACKGROUND: Moral reasoning is important for developing medical professionalism but current evidence for the relationship between education and moral reasoning does not clearly apply to medical students. We used a combined study design to test the effect of clinical teaching on moral reasoning. METHODS: We used the Defining Issues Test-2 as a measure of moral judgment, with 3 general moral schemas: Personal Interest, Maintaining Norms, and Postconventional Schema. The test was applied to 3 consecutive cohorts of second year students in 2002 (n = 207), 2003 (n = 192), and 2004 (n = 139), and to 707 students of all 6 study years in 2004 cross-sectional study. We also tested 298 age-matched controls without university education. RESULTS: In the cross-sectional study, there was significant main effect of the study year for Postconventional (F(5,679) = 3.67, P = 0.003) and Personal Interest scores (F(5,679) = 3.38, P = 0.005). There was no effect of the study year for Maintaining Norms scores. 3(rd) year medical students scored higher on Postconventional schema score than all other study years (p<0.001). There were no statistically significant differences among 3 cohorts of 2(nd) year medical students, demonstrating the absence of cohort or point-of-measurement effects. Longitudinal study of 3 cohorts demonstrated that students regressed from Postconventional to Maintaining Norms schema-based reasoning after entering the clinical part of the curriculum. INTERPRETATION: Our study demonstrated direct causative relationship between the regression in moral reasoning development and clinical teaching during medical curriculum. The reasons may include hierarchical organization of clinical practice, specific nature of moral dilemmas faced by medical students, and hidden medical curriculum