Profesionalna etička osposobljenost kao instrument za vrednovanje etičnosti i etičke osposobljenosti studenata medicine [Professional ethical competences questionnaire as a tool for evaluating medical students' professional ethical competences]

Aim: This research was conducted with the main aim to develop an instrument for the assessment of medical students’ professional ethical competences in patients’ autonomy issues and to analyze trends in ethical competences among medical students in different years, according to their socio-demographic characteristics and desired specialization. Material and methods: Research was performed in two phases. First, qualitative research was conducted by means of six focus group discussions held in the years 2012 and 2013 in Croatia. Focus groups were held separately with each of the following: first year and final (6th) year medical students, physicians engaged in medical ethics education, physicians practicing in a clinical hospital, family medicine residents and individuals representing patients with chronic disease. Obtained data were used to construct the instrument Professional Ethical Competence Questionnaire (acronym: PECQ ). Subsequently, PECQ was administered to medical students of Zagreb School of Medicine: 1st year (N=291), 3rd year (N=121) and 6th year (N=124). Results: Qualitative results show that ethical problems regarding patients’ autonomy issues are frequent in clinical practice. Medical education should deal with these issues appropriately. Quantitative analysis of the PECQ Instrument revealed that different styles can be identified in dealing with patient autonomy issues. Each question should be analyzed separately in line with the clinical context described in the vignette. Nevertheless, the most frequent style in medical decision taking was patient understood as a partner. The least frequent style was defensive/legalistic approach to the patient. Differences in students’ answers were found according to their year of study, sex, desired specialization and place of growing up. No differences were found in relation to parents’ education, age and religiosity. Conclusion: PECQ is an applicable and useful instrument to assess medical students’ professional ethical competence in patients’ autonomy issues

Neprepoznata ohronoza - prikaz slučaja

Alkaptonuria is a rare metabolic disorder characterized by a deficiency of the homogentisic acid oxidase enzyme. The result is accumulation of homogentisic acid in collagenous structures throughout the body, especially in fibrous and cartilaginous tissue. This leads to gradual development of a phenomenon known as ochronosis. Characteristic features of ochronosis are urine darkening, progressive scleral pigmentation, subcutaneous cartilage pigmentation (for example, ear cartilage and nails) and degenerative ochronotic arthropathy resembling osteoarthritis. In addition, cardiovascular and genitourinary systems are also affected. Alkaptonuric ochronosis is particularly interesting because it can be detected based only on clinical signs and medical history. Herein we present a patient with typical signs and symptoms such as darkening of urine, pigmented sclerae, nails and ear cartilage, manifesting arthritis in his fifth decade. Additional clinical examination indicated alkaptonuria, which was unrecognized in childhood.Alkaptonurija je rijedak poremećaj metabolizma koji nastaje zbog manjka oksidaze homogentizinske kiseline. Posljedica toga je nakupljanje homogentizinske kiseline u kolagenskim strukturama cijelog tijela, osobito u fibroznim i hrskavičnim tkivima. To postupno uzrokuje nastajanje pojave nazvane ohronoza. Ona podrazumijeva znakovite promjene poput tamnjenja boje mokraće, progresivne pigmentacije bjeloočnice, pigmentacije potkožne hrskavice (na primjer, hrskavice na uškama i noktima) te degenerativne ohronotske artropatije nalik osteoartritisu. Uz to, zahvaćeni su i kardiovaskularni i genitourinarni sustavi. Bolesnik je obično bez simptoma do trećeg ili četvrtog desetljeća života. Zasad ne postoji specifično i djelotvorno etiološko liječenje, ali je važno primjereno zbrinjavati simptome i brinuti se o bolesnikovoj kvaliteti života. U težim slučajevima moguća je kirurška zamjena zglobova i aortnih zalistaka. Fizioterapija, analgezija i primjerena antiosteoporotska terapija su neophodni za sprječavanje invalidnosti. Navedeni poremećaj je zanimljiv, jer se može jednostavno otkriti samo na osnovi pojedinosti iz povijesti bolesti i kliničkih znakova

Hagioterapija, depresivnost i ljestvica životnih vrijednosti

Sve je veći broj stručnih radova koji ukazuju na dobrobit uključivanja duhovno/religioznih čimbenika u liječenje mentalnih bolesti. U Hrvatskoj postoji autentični model pružanja duhovne pomoći, pod nazivom hagioterapija. Ona se temelji na načelu da je svaka osoba duhovno/egzistencijalno biće koje u sebi nosi prirodni moralni zakon po kojem se specifično razlikuje od svih ostalih stvorenja. Područje rada hagioterapije je tzv. "duhovna duša". Egzistencijalistički filozofi ukazuju na trostruki izvor depresije: psihološki, biološki i egzistencijalni. Egzistencijano/duhovna depresija koju je opisao Park podudara se s opisom moralne patnje i boli opisane od Ivana Pavla II te s patnjom duhovne duše koju je opisao prof. Ivančić. Autori predstavljaju pilot istraživanje provedeno na 42 osobe koje su poradi depresivnih simptoma zatražile hagioterapijsku pomoć u Centru za duhovnu pomoć u Zagrebu (CDP). Hagioterapija je primjenjena u oko sedam individualnih tretmana po osobi. Prije i poslije tretmana proveden je polustrukturirani intervju te je utvrđen intenzitet depresivnosti samoocjenskom skalom Beck Depression Inventory. Rezultati potvrđuju značajan pad u intenzitetu depresivnosti i značajne razlike u skali životnih vrijednosti nakon primjene hagioterapije

Validation of the Croatian Version of the Duke Religion Index (DUREL-hr) among Medical School Students

The purpose of this study was to develop and examine the psychometric properties of the Croatian version of the Duke Religion Index (DUREL-hr) and to examine religiousness trends among different years medical students. Our results demonstrated high internal consistency (coefficient alpha ranging from 0.883 for the total scale to 0.9398 for the intrinsic subscale) of DUREL-hr as well as students’ religiousness results comparable to other studies on the religiousness of the youth in Croatia. DUREL-hr is a reliable and valid instrument suitable to use in Croatian language. Authors encourage studies on the relationship of religiousness and health in Croatia

Validation of the Croatian Version of the Duke Religion Index (DUREL-hr) among Medical School Students

The purpose of this study was to develop and examine the psychometric properties of the Croatian version of the Duke Religion Index (DUREL-hr) and to examine religiousness trends among different years medical students. Our results demonstrated high internal consistency (coefficient alpha ranging from 0.883 for the total scale to 0.9398 for the intrinsic subscale) of DUREL-hr as well as students’ religiousness results comparable to other studies on the religiousness of the youth in Croatia. DUREL-hr is a reliable and valid instrument suitable to use in Croatian language. Authors encourage studies on the relationship of religiousness and health in Croatia

Hagioterapija, depresivnost i ljestvica životnih vrijednosti

Sve je veći broj stručnih radova koji ukazuju na dobrobit uključivanja duhovno/religioznih čimbenika u liječenje mentalnih bolesti. U Hrvatskoj postoji autentični model pružanja duhovne pomoći, pod nazivom hagioterapija. Ona se temelji na načelu da je svaka osoba duhovno/egzistencijalno biće koje u sebi nosi prirodni moralni zakon po kojem se specifično razlikuje od svih ostalih stvorenja. Područje rada hagioterapije je tzv. "duhovna duša". Egzistencijalistički filozofi ukazuju na trostruki izvor depresije: psihološki, biološki i egzistencijalni. Egzistencijano/duhovna depresija koju je opisao Park podudara se s opisom moralne patnje i boli opisane od Ivana Pavla II te s patnjom duhovne duše koju je opisao prof. Ivančić. Autori predstavljaju pilot istraživanje provedeno na 42 osobe koje su poradi depresivnih simptoma zatražile hagioterapijsku pomoć u Centru za duhovnu pomoć u Zagrebu (CDP). Hagioterapija je primjenjena u oko sedam individualnih tretmana po osobi. Prije i poslije tretmana proveden je polustrukturirani intervju te je utvrđen intenzitet depresivnosti samoocjenskom skalom Beck Depression Inventory. Rezultati potvrđuju značajan pad u intenzitetu depresivnosti i značajne razlike u skali životnih vrijednosti nakon primjene hagioterapije

Validation of the Croatian version of the Duke Religion Index (DUREL-hr) among medical school students

The purpose of this study was to develop and examine the psychometric properties of the Croatian version of the Duke Religion Index (DUREL-hr) and to examine religiousness trend among medical students of different study years. Our results demonstrated high internal consistency (Coefficient Alpha ranging from 0.883 for the total scale to 0.9398 for the intrinsic subscale) of DUREL-hr as well as students’ religiousness results comparable to other studies on the religiousness of the youth in Croatia. DUREL-hr is a reliable and valid instrument suitable to use in Croatian language. Authors encourage studies on the relationship of religiousness and health in Croatia

Family medicine - A safe future

Cilj: Istražiti stavove pacijenata prema obiteljskoj medicini, odnosno ustanoviti pridonosi li obiteljska medicina kvalitetnijoj zdravstvenoj skrbi pojedinca i obitelji, kao i doznati razloge koji su važni za postojanje obiteljske medicine u zdravstvenom sustavu urbanih i ruralnih područja. Ispitanici i metode: U četiri gradske i četiri seoske ordinacije provedeno je presječno istraživanje. Anketama koje su ispunjavali pacijenti stariji od 18 godina prikupljeni su podaci o dobi, spolu, stručnoj spremi, te broju članova obitelji koji su u skrbi istog obiteljskog liječnika. Ispitanici su odgovarali na pitanje drže li da obiteljska medicina pridonosi kvalitetnijoj zdravstvenoj skrbi za pojedinca i obitelj, te što drže razlozima koji su važni za postojanje obiteljske medicine. Rezultati: Uzorak je sačinjavalo 960 ispitanika, od čega 428 (44,58%) muškaraca i 532 (55,42%) žene. Većina ispitanika (N = 382, 39,79%) bila je starija od 60 godina. 494 (51,46%) ispitanika registrirano je u seoskim, a 466 (48,54%) u gradskim ordinacijama obiteljske medicine. Većina ispitanika u seoskim ordinacijama imala je nižu stručnu spremu (N = 277, 56,07%), dok je većina ispitanika u gradskima ordinacijama imala srednju stručnu spremu (N = 302, 64,81%). Značajno veći udio ispitanika u seoskim ordinacijama (N = 145, 29,35%) naveo je da su svi članovi obitelji u skrbi istoga liječnika (χ 2 = 23,27, p < 0,001). Od 960 ispitanika, njih 736 (76.67%) u potpunosti se složilo da obiteljska medicina pridonosi kvalitetnijoj skrbi. Za 510 (53.13%) ispitanika najvažniji razlog postojanja obiteljske medicine bio je poznavanje pacijenta. Zaključak: Sukladno stavovima pacijenata obiteljska medicina osigurava cjelokupnu, kontinuiranu skrb za pacijenta i doprinosi kvaliteti zdravstvene skrbi u cjelini.Aim: To investigate patients’ attitudes regarding family medicine, their opinion on the contribution of family medicine to the quality of health care and their perception of family medicine advantages. Participants and methods: A cross-sectional questionnaire-based study was performed in four urban and four rural family practices. Patients aged 18 years or more provided data on their age, sex, educational level and proportion of family members who were in care of the same family doctor. Patients expressed their opinion on the contribution of family medicine to the quality of health care and their perception of family medicine advantages. Results: Out of 960 patients, 428 (44.58%) men and 532 (55.42%) women, 494 (51.46%) patients were registered in urban and 466 (48.54%) in rural family practices. Most of the patients (N = 382, 39.79%) were aged 60 years or more. The majority of patients in rural practices had finished primary school (N = 277, 56.07%) and the majority of patients in urban practices had finished secondary school (N = 302, 64.81%). A significantly higher proportion of patients in rural practices reported having one family doctor taking careof all family members (N = 145, 29.35%) (χ 2 = 23.27, p < 0.001), 736 (76.67%) patients fully agreed that family medicine contributes to higher care quality. For 510 (53.13%) patients, the main advantage of family medicine was knowing the patient. Conclusion: According to patients’ opinion, family medicine provides holistic, continuing care to patients and contributes to a higher quality of health care

CARE QUALITY FOR PATIENTS WITH CORONARY ARTERY DISEASE IN FAMILY MEDICINE - GUIDELINE IMPLEMENTATION BY TAKING A GLANCE AT THE RISK FACTORS

Uvod: Bolesnici s koronarnom bolešću su velik izazov u skrbi liječnika obiteljske medicine (LOM) zbog brojnih komorbiditeta te primjene mjera sekundarne prevencije kojima se prate i istovremeno korigiraju rizični čimbenici koji se odnose na bolesnika, njegovu okolinu i stil života. Cilj: Istražiti uspješnost LOM-a u primjeni mjera sekundarne prevencije kardiovaskularnih bolesti i pronaći moguće rješenje za poboljšanje kvalitete skrbi. Ispitanici i metode: Opservacijsko istraživanje provedeno je 2017. godine u devet specijalističkih ordinacija obiteljske medicine diljem Hrvatske, a uključivalo je 169 bolesnika koji su ili preboljeli infarkt miokarda i/ili su bili podvrgnuti perkutanoj koronarnoj intervenciji i/ili operaciji aortokoronarnog premoštenja. Praćene su vrijednosti krvnog tlaka, LDL kolesterola i indeksa tjelesne mase, a ispitivano je pridržavanje poželjnih oblika ponašanja (nepušenje, tjelesna aktivnost, pravilna prehrana, redovno uzimanje dokazano djelotvornih lijekova) te prilagodba novom stilu života koja je mjerena Likertovom ljestvicom (1-5) kao i zadovoljstvo liječnika preglednošću elektroničkog zdravstvenog zapisa. Rezultati: Zadovoljavajuće vrijednosti arterijskog tlaka postignute su u 63,2 % ispitanika, razinu LDL kolesterola prema smjernicama imalo je 19,4 %, dok je 25,3 % ispitanika imalo uredan indeks tjelesne mase; 25,1 % ispitanika je i dalje pušilo, dok je 43,2 % ispitanika konzumiralo alkohol. Prehrambene navike promijenilo je 63,7 % ispitanika, a 63,4 % je povećalo svoju tjelesnu aktivnost. LOM je u većini slučajeva proveo savjetovanje oko promjene životnog stila nakon koronarnog incidenta. Liječnici su većinom bili zadovoljni sadržajem i količinom podataka u elektroničkom zdravstvenom zapisu, ali ne i njihove upotrebljivosti u svakodnevnoj, vremenski ograničenoj konzultaciji s bolesnikom. Osmišljeno rješenje u programu Adobe Illustrator® omogućilo bi i olakšalo bolju preglednost rizičnih čimbenika i time bi moglo imati utjecaja na učinkovitiju kontrolu provođenja mjera sekundarne prevencije. Zaključak: Skrb za bolesnike s koronarnom bolešću u obiteljskoj medicini je vrlo kompleksna, a dio kompleksnosti se odnosi na primjenu mjera sekundarne prevencije koje su od vitalne važnosti. Zbog toga je potrebno planirati i osigurati dovoljno vremena za konzultaciju s takvim bolesnicima kako bi se dobio uvid u kontrolu rizičnih čimbenika i pravovremeno učinile promjene sukladno važećim smjernicama. Rezultati istraživanja pokazali su da se u bolesnika svi rizični čimbenici ne nalaze unutar preporučenih vrijednosti te da je jedan od mogućih razloga tome što ne postoji njihov pregledan prikaz u elektroničkom zdravstvenom zapisu. Kvalitetnija skrb mogla bi se postići kada bi postojalo jasno vizualno rješenje stanja rizičnih čimbenika koje je u ovom radu osmišljeno i predloženo u obliku slika koje bi LOM-u dale brzi uvid u “profi l” bolesnika te poboljšale učinkovitost svake konzultacije s obzirom na njeno kratko vremensko ograničenje u svakodnevnim uvjetima rada u ordinacijama obiteljske medicine.Introduction: Patients with coronary artery disease represent a challenge in each family medicine practice because of many comorbidities and the application of secondary prevention measures which represent a tool for tracking and simultaneously correcting risk factors related to the patient, his surroundings and lifestyle. Objective: Explore the effectiveness of family medicine specialists in applying secondary prevention measures in cardiovascular diseases and to find a solution for improving quality of care. Participants and Methods: This observational study, was conducted in 2017. under nine specialised family medicine practices throughout Croatia and included 169 patients who suffered from myocardial infarction and/or underwent percutaneous coronary intervention and/or bypass surgery. Blood pressure, LDL cholesterol and body mass index were measured and it was examined whether the participants were abiding to the advised healthy habits (nonsmoking, physically active, good diet, regular use of medicaments according to the guidelines). Adjustment to the new lifestyle was measured with Likert scale (1-5) and the same scale was used to asses physicians satisfaction with transparency of electronic health record data. Results: 63.2% of participants had recommended values for blood pressure, 19.4% for LDL cholesterol and 25.3% had a normal body mass index according to the guidelines. 25.1% of participants continued to smoke and 43.2% continued alcohol consumption. In terms of diet, a change was observed in 63.7% and physical activity increase in 63.4% of participants. In most cases, after coronary incident, physician consulted them regarding lifestyle changes. Family medicine specialists were mostly pleased with the content and the amount of data in electronic health records, but not with their transparency and ease of use in everyday, usually time constrained, patient - doctor consultations. A software application Adobe Illustrator® was used to visually represent the relevant risk factors which could provide more effective control for conducting secondary prevention measures. Conclusion: The care for coronary artery disease patients in family medicine is very complex, and a part of it is related to providing effective measures of secondary prevention which are of crucial importance. Therefore it is imperative to plan ahead and allow sufficient consultation time to obtain control over the risk factors and make timely changes according to the guidelines. Research results have shown that not all risk factors are within recommended values and one of the reasons could be the lack of clear presentation in the electronic health record. Better quality of care could be achieved with the proposed visual solution using pictures that allows the family physician fast access to the patient’s “profile” and improves efficiency of every consultation despite its constrained duration in everyday conditions