VASCULAR VIBRATION INJURY AND PAGET-SHROETTER SYNDROME

Sindrom Paget-Schroetter je relativno rijetko medicinsko stanje koje označava primarnu trombozu aksilarne vene odnosno vene supklavije na kostoklavikularnom spoju. Vibracijska ozljeda rijedak je etiološki čimbenik u nastanku ovog kliničkog entiteta. Prikazujemo slučaj 28-godišnjeg muškarca koji se prezentirao s akutno nastalim edemom lijeve ruke nakon cjelodnevnog rada s pneumatskom bušilicom. Vaskularnim ultrazvukom dokazan je tromb u lijevoj aksilarnoj veni te u veni supklaviji, te je započeta terapija niskomolekularnim heparinom.Paget-Schroetter syndrome is a relatively uncommon condition related to primary thrombosis of the axillary/subclavian vein at the costoclavicular junction. Vibration injury is an unusual cause of this syndrome. We report on a 28-year-old man who presented with acute onset left arm swelling after whole-day work with a pneumatic drill. Duplex ultrasound confirmed the presence of a thrombus in his left axillary and subclavian vein, which was treated with low molecular weight heparin, eventually switched to oral anticoagulation

The impact of interventions to improve adherence to preventive measures on the incidence of nosocomial infections in ICUs

Half of all life-threating nosocomial infections occur in intensive care units (ICUs) and, despite the advances in intensive care, the incidence of nosocomial infections is still high. About one third of nosocomial infections are considered preventable. Awareness of risk factors, adherence to preventive measures and collaboration of all members participating in preventive programmes can lead to reduction of the incidence of nosocomial infections and thus can produce a positive impact on reducing morbidity, mortality and healthcare costs. A retrospective surveillance study was performed in a 14-bed medical ICU to identify device-related infections before and after the preventive interventions. Ventilator-associated pneumonia (VAP), central line-associated bloodstream infections (CLABSI) and catheter-associated urinary tract infections (CAUTI) were obtained and compared before and after the interventions. In the year before the interventions, device-related nosocomial infections were diagnosed in 7.9% out of 737 hospitalised patients in the ICU, and in the year after the interventions they were diagnosed in 5.1% out of 684 hospitalised patients. Before the interventions, the infection rates were distributed as follows: 7.5 CLABSI/1000 catheter days, 28.4 VAP/1000 ventilator days, 6.5 CAUTI/1000 catheterisation days. After the interventions, the rates were distributed as follows: 2.5 CLABSI/1000 catheter days, 26.5 VAP/1000 ventilator days and 4.1 CAUTI/1000 catheterisation days. The implementation of effective preventive measures and maintaining strict surveillance is the basis of limiting the risk of nosocomial infections. Since hospital nosocomial infection rate is considered an indicator of quality and safety of care, all infection control activities are focused to decrease rate of nosocomial infections

Medical teachers' attitudes towards science and motivational orientation for medical research

BACKGROUND: Research is an important motivating factor for pursuing a career in academic medicine, but the relation between motivation and other factors involved in scientific research are not clear. ----- PURPOSE: To explore the motivational orientation for doing research and its relation with attitudes towards science and publication practice among members of faculty at a medical school. ----- METHODS: We used a Science Attitude Survey and the Work Preference Inventory (intrinsic and extrinsic motivational orientation using 4 Likert-type scales of motivation, possible range 1-5) to survey two groups of teachers at the Zagreb University School of Medicine (n = 327, 66% response rate): professors, elected to tenure-track positions (n = 150), and instructor/research fellows working on or just completing their thesis (n = 177). RESULTS: Overall, teachers scored highest on the Enjoyment subscale of intrinsic motivational orientation (mean score +/- standard deviation 4.3 +/- 0.42 for professors vs 4.1 +/- 0.42 for instructors/research fellows, P = 0.001, t-test). Professors also scored higher than instructors/research fellows on the Challenge subscale of intrinsic motivational orientation (3.8 +/- 0.55 vs. 3.5 +/- 0.64, P < 0.001, t-test), whereas instructors/research fellows scored higher on the Compensation subscale of extrinsic motivational orientation (3.5 +/- 0.74 vs. 3.1 +/- 0.71, P < 0.001, t-test). Multiple linear regression analysis showed that the number of publications was positively associated with scores on the Science Attitude Survey and the Challenge subscale of intrinsic motivation, and negatively associated with scores on the Compensation subscale of extrinsic motivation. ----- CONCLUSIONS: Members of the medical faculty differ in motivational orientation for research depending on their academic status, and their motivation is associated more with requirements for academic advancement than with research. These findings have important implications for developing strategies for enhancing academic research production